Problems with pay-for-performance
February 21, 2011 Leave a comment
If pay-for-performance doesn’t work in medicine, what should our expectations be for its success in education?
“No matter how we looked at the numbers, the evidence was unmistakable; by no measure did pay-for-performance benefit patients with hypertension,” says lead author Brian Serumaga.
Interestingly, hypertension is “a condition where other interventions such as patient education have shown to be very effective.”
According to Anthony Avery… “Doctor performance is based on many factors besides money that were not addressed in this program: patient behavior, continuing MD training, shared responsibility and teamwork with pharmacists, nurses and other health professionals. These are factors that reach far beyond simple monetary incentives.”
It’s not hard to complete the analogy: doctor = teacher; patient = student; MD training = pre-service and in-service professional development; pharmacists, nurses and other health professionals = lots of other education professionals.
One may question whether the problem is that money is an insufficient motivator, that pay-for-performance amounts to ambiguous global rather than specific local feedback, or that there are too many other factors not well under the doctor’s control to reveal an effect. Still, this does give pause to efforts to incentivize teachers by paying them for their students’ good test scores.
B. Serumaga, D. Ross-Degnan, A. J. Avery, R. A. Elliott, S. R. Majumdar, F. Zhang, S. B. Soumerai. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ, 2011; 342 (jan25 3): d108 DOI: 10.1136/bmj.d108