How Pay For Performance Saved Prisoners Lives in the 19th Century

pay-for-performance-modelDuring the 1800s, the British empire shipped prisoners to newly formed penal colonies in Australia (technically, these were British prisoners, but that doesn’t make a catchy title). Ship captains were compensated for each prisoner who boarded the ship. The financial incentive ruled over decency, each captain stuffed as many prisoners on to the ship as it could handle. Of course, the prisoner survival rate lingered at a precarious 50%, while those who managed to survive the journey often arrived beaten, sick or starving…

[Then] in 1862…ship captains were no longer compensated for each prisoner who boarded in England, but, instead, received payment for every living prisoner who got off the ship in Australia. The first pay for outcomes program in healthcare. The survival rate on ensuing trips jumped from 50% to 98%.

Chris Denoia.

Comments (10)

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  1. Rutledge says:

    How should we align the incentive structure in health care?

    • Crawford says:

      A key should be increasing the role that primary care physicians have. I’m tired of them simply referring me to a “specialist”

    • Sharon says:

      As stated within the environmental blog posted by Paul Chesser, it seems that trees could fill that incentive gap. As nearly 6 million dollars was put towards it

    • Dewaine says:

      Providers should get paid for a job well done, not just a job undertaken. It is the same concept as with the prisoner ships.

  2. JD says:

    Wow. Who came up with the first system? Does that make sense at all?

  3. BHS says:

    That’s a great story.