Patient Opinions Regarding ‘Pay for Performance for Patients’

  • Judith A. LongEmail author
  • Marie Helweg-Larsen
  • Kevin G. Volpp
Original Article



Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown.


To assess patients’ opinion of the acceptability of P4P4P.


Cross-sectional self-administered survey.


Patients in waiting rooms in two university-based primary care clinics.


Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes.


Respondents were split on whether P4P4P is desirable. Thrity-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41–44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts.


Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.


pay for performance patient acceptance of health care financial management 



The work in this paper was supported by a grant from the Commonwealth of Pennsylvania, titled Collaboration to Reduce Disparities in Hypertension, grant no. ME-02-382.

The Commonwealth bears no responsibility for the content of this article. This paper was presented as a poster at the Society of General Internal Medicine 2007 National Meeting in Toronto, Canada, 2007.

Conflict of Interest

Drs. Long and Helweg-Larsen have no conflicts of interest in relationship to this work. Dr. Volpp received an honorarium from Astra Zeneca for convening a conference on medication adherence as well as receiving investigator initiated grant support from Pfizer for ongoing patient follow-up for a randomized controlled trial of copayment reductions that was initiated through the grant that also supported this work (the Commonwealth of Pennsylvania sponsored Collaboration to Reduce Disparities in Hypertension, grant no. ME-02-382).

Supplementary material

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Judith A. Long
    • 1
    • 2
    • 3
    Email author
  • Marie Helweg-Larsen
    • 4
  • Kevin G. Volpp
    • 1
    • 2
    • 3
    • 5
  1. 1.Philadelphia VA Center for Health Equity Research and PromotionPhiladelphiaUSA
  2. 2.University of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.University of Pennsylvania Leonard Davis Institute for Health EconomicsPhiladelphiaUSA
  4. 4.Dickinson CollegeCalisleUSA
  5. 5.Department of Health Care Systemsthe Wharton SchoolPhiladelphiaUSA

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