Pay for performance in Australia: Queensland's new Clinical Practice Improvement Payment

Following a high profile scandal relating to quality and safety of care, the health authority in the Australian state of Queensland introduced a pay for performance (P4P) component into its new hospital prospective payment system. The Clinical Practice Improvement Payment system pays hospitals for achievement of clinical process indicators. Initially the focus is on the quality of clinical processes and outcomes. Using a consensus approach involving consultation with clinicians, seven clinical indicators were adopted for 2007–2008. The first payments using pay for performance were made for work carried out up until June 2008. Although no data exist yet as to the impact of the new system, pay for performance appears to be gaining widespread, if somewhat reluctant, acceptance.