It isn’t surprising that pay for performance leads to better performance. People respond to incentives. However, the issue is that people under normal circumstances will not pay more to go see a superior physician. The best predictor of which doctor an individual will see is not their performance or standard of care, but whether or not the doctor takes their insurance. More doctors and physicians than ever are leaving Medicare given the low reimbursement rates and mounting rules, in seek of better pay. The restrictions of government funded health care means that people will go to the providers that accept their insurance and not necessarily the best available.