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 showing that clearly 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 a way to risk adjust and combat disparities. Other countries have found ways, risk adjustment should be a mandatory aspect as this time in the United States.  All of these controversies should not scare clinicians of P4P, rather they should suggest alternative plan opportunities to solve these controversies.