Pay-for-performance (P4P) programs are broadly defined as performance-based payment arrangements that are designed to promote improvement in health care quality while reducing costs. Often absent in the equation is the issue of disparities. Racial and ethnic disparities in health care persist, and some believe that P4P programs have the potential to exacerbate such inequities in the quality of care received by minority patients.In an HCFO-funded study, Joel S.