What are the underlying goals of P4P and fee-for-service models?


The fee-for-service model of health care is neutral with regard to differences in the quality of health care. The pay-for-performance (P4P) model of health care attempts to set targets to measure quality care. If quality targets are met, providers are rewarded financially. This model is gaining increased popularity in both the public and private sectors. It is, however, not without its critics.

In this week’s Discussion, you and your colleagues will compare and contrast the pay-for-performance model and the fee-for-service model of health care.

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To prepare for this Discussion:

  • Consider how the P4P model affects the overall quality and profit margin of health care.
  • Consider how the traditional fee-for-service model affects the overall quality and profit margins of health care providers.

By Day 4, post a comprehensive response to the following:

  • What are the underlying goals of P4P and fee-for-service models?
  • Are there risks to patients in a P4P model?
  • If you were a patient, which model would you prefer the hospital to follow? Why?
  • If you were a provider, which model would you prefer to be paid for? Why?

Required Resources


  • Video: Dentzer, S. (2006). National campaign aims to curb hospital mistakes, saves lives. Retrieved from http://www.pbs.org/newshour/bb/health/july-dec06/lives_08-18.htmlThis video presentation includes an interview with Dr. Donald Berwick discussing the 100,000 Lives Campaign. There is also an option to download the audio only.


  • Course TextJonas & Kovner’s Health Care Delivery in the United States
    • Chapter 11, “High Quality Health Care”

    This chapter defines quality of health care and how differing definitions of quality care are influenced by the perspective of different stakeholders. Chapter 11 also addresses basic strategies for managing quality within the inherent complexity of health care organizations.

  • Article: Robert Wood Johnson Foundation. (2008). The current state of health care quality. Retrieved from http://www.rwjf.org/pr/product.jsp?id=30711

This article provides an overview of three key concerns in quality health care: underuse, overuse, and misuse of resources. The full article is available for download by scrolling down the page to the Publication and Resources section and clicking Download to view “The Current State of Health Care Quality Overview.”

  • Article: Wharam, J. F., & Sulmasy, D. (2009). Improving the quality of health care: Who is responsible for what? JAMA: The Journal of the American Medical Association, 301(2), 215–217. Retrieved from http://jama.ama-

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