Pay-for-performance programs to reduce racial/ethnic disparities: limitations of a one-size-fits-all approach.

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. For example, P4P programs could incent hospitals to give preference to patients who are more likely to generate improved quality scores, thus reducing overall access to other patients. Moreover, when facing additional performance requirements, hospitals starting out with fewer resources may not perform as well as financially robust providers.