Accountability metrics and paying for performance in education and health care.

The track record in paying for performance in education is not good; nevertheless, emphasis on accountability and performance has gained momentum in the last 25 years. This emphasis includes systems of merit pay, career ladders, and national board certification. The general failures of these efforts have led some reformers to suggest that teacher pay be directly related to student value-added performance. This suggestion remains controversial but is also the hottest topic in paying for performance in education. Although many similarities exist between education and health care, major differences may make it even harder to install pay-for-performance systems in health than in education. If those systems are to be tried, experiments should begin in a bottom-up fashion at the unit level, rather than being imposed systemwide.