Paying physicians to hit performance targets is becoming increasingly fashionable, as evidenced by the growing number of “pay-for-performance” programs in the United States and beyond. This article compares pay-for-performance initiatives in two nations—the United Kingdom and the United States. It pays particular attention to the context in which the initiatives were conceived and implemented, factors which are largely neglected in the pay-for-performance literature. Despite some glowing reviews of the UK national pay-for-performance program for primary care doctors, we suggest that such programs face significant technical obstacles in all cases and particularly severe institutional obstacles in the United States.

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