Like any attempt to regulate physician behavior, the unintended consequences often worsen the situation:
[P4P] also led to unintended effects, such as . . . potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefiting financially from payments, and concerns about an ongoing culture of performance monitoring.
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