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Paying incentives to physicians for meeting certain standards of care (pay-for-performance [P4P]) might improve some process measures and intermediate outcomes, but whether P4P affects population-wide health is unknown. The U.K.'s nationwide Quality and Outcomes Framework (QOF) is the world's largest P4P program. Since the program's introduction in 2004, as much as 25% of all primary care physicians' income has been tied to performance on 136 indicators that are related to chronic disease management, care organization, and patient experience. Performance on such indicators improved during the first year after QOF was introduced but then plateaued (NEJM JW Gen Med Aug 15 2009 and N Engl J Med 2009; 361:368). Now, researchers have compared ch…