This section is devoted to providing a ten-thousand-foot view of pay-for-performance (P4P), which has many definitions. Features common to most definitions include an insurer or health system awarding a periodic bonus to clinicians or practices that reach particular quality goals. There are three types of quality markers: structure (ex. use of EMR), process (ex. checking HbA1c every 3 months in type 2 diabetics), or outcome (ex. HbA1c < 8.0%). Programs are currently free to choose the measures and rewards that they see fit. The reward, or incentive, is typically a cash bonus ranging from program to program between 1% and 25%. Most P4P rewards are over and above traditional fee for service or capitated payments. However, some P4P programs are funded by withholding a percentage of the traditional payments. Apart from pure P4P programs, insurers and health systems are using incentives such as physician report cards and tiering to exert additional financial and social pressure for clinicians to achieve quality goals.  Historically, P4P was conceived of as a quality improvement tool. More recently, it has been described as a strategy for promotion of cost-effectiveness or value-based care. From its inception, P4P has been surrounded by controversy, which is discussed in detail throughout this website, most specifically in the Controversial Issues section.