Pay for performance might embed inequalities

Abstract

Majeed and Molokhia provide an insightful assessment of the Quality and Outcomes Framework (QOF).1 But their focus on administrative burdens and diminishing returns may understate a more perilous consequence: pay-for-performance schemes might systematically embed, as opposed to alleviate, health inequalities. The intrinsic design of pay-for-performance schemes is fundamentally misaligned with the needs of the most vulnerable patients for whom the linear, single disease …