Strong versus Weak Incentives: The Role of Policy, Management, and Theory in a New Research Agenda.

The papers in this Special Issue provide an excellent overview of the current state of the research literature around improving the value of the U.S. health care system and offer a range of sensible new directions for future research. The papers address both payment incentives, noting the strengths and weak-nesses in theory and practice of fee-for-service, capitation, and salary payments; and informational incentives, including pay-for-performance (which combines payment and performance measurement), public reporting, peer review, and the role of patient-reported information. They point out that the most appropriate payment or information approach is likely to depend on the nature and setting of care. They also point to the layers and multiplicities of incentives that often exist in our fragmented health care system. Insurers may, for example, pay a group practice a capitation rate for services, while the practice pays its provider employees using salaries, or by fee-for-service. Payers may monitor hospital outcomes, while hospitals monitor the productivity of their employees. Medicare may offer hospitals bundled payments that include postacute care, while the dominant area private insurer may pay using hospi-tal-only diagnosis-related groups (DRGs). The U.S. health care system is noth-ing if not complicated. As the papers show, we have learned a lot, and could plausibly learn a lot more. Yet after reading the papers, it is clear that the challenge ahead remains daunting. There is an enduring mismatch between the very limited array of instruments at our disposal — money and information — and the nearly in fi nite and endlessly evolving set of contexts that those instruments must address. Research studies tend to examine speci fi c elements of these enor-mously complicated interactions, but drawing more out of the research will