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This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence.

OBJECTIVES: To assess the impact of Medicare Part D in the nursing home (NH) setting. DESIGN: A population-based study using 2005/06 prescription dispensing records, Poisson regressions with generalized estimating equations, and interrupted times series estimation with segmented regression methods. SETTING: Nursing Homes. PARTICIPANTS: A nationwide sample of long-stay Medicare enrollees in NHs (N=861,082). MEASUREMENTS: Probability of Part D enrollment, changes in source of drug payments, changes in average number of monthly prescriptions dispensed per resident.

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Objective. We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance. Data Sources. We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.(1) Study Design. Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill. Results.

Objective. Analyze trends in hospital cost and revenue, as well as price and quantity (1994-2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Data. Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. Study Design. A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. Principal Findings.

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care.