Table 1.

Potential Ethical Problems in the Implementation of Pay-for-Performance

I. Lack of proven safety and benefit for patients

II. Inadequate definitions of quality

III. Inadequate measures of quality

IV. Misallocating the locus of accountability for quality improvement

V. Potential for adverse effects on patients and vulnerable populations

VI. Potential for adverse effects on physicians

VII. Potential for adverse effects on society

VIII. Lack of structured monitoring for adverse outcomes