• Stephen Buetow and Vikki Entwistle.
• Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand. s.buetow@auckland.ac.nz
• J Eval Clin Pract. 2011 Oct 1; 17 (5): 894-8.

AbstractPay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation.© 2011 Blackwell Publishing Ltd.

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