Controversial Issues

Controversial Issues the corresponding literature contains six sections:

  • Designing Measures
  • Disparities and Risk Adjustment
  • Disputing Guidelines
  • Ethical Issues
  • Patient Satisfaction
  • Unintended Consequences


Website Authors' Opinion

It is not easy to measure the effects of P4P on most controversial issues. However, Shen (241) did an excellent job of clearly showing that P4P led to patient selection. More studies of this nature are necessary to control the expansion of P4P. Perhaps the most intimate ethical issue centers on the doctor-patient relationship. The importance of this relationship cannot be underestimated, and must not falter as P4P changes the delivery of care. Because measures are changing constantly, there must be a way for P4P program developers to streamline evidence changes into programs. Furthermore, it is vital to the success of P4P to find ways to risk adjust and combat disparities. Other countries have found ways, and risk adjustment should be a mandatory aspect at this time in the United States.  All of these controversies should not scare clinicians away P4P, rather they should suggest alternative plan opportunities to help solve these controversies.