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PurposeThis paper aims to describe the introduction of pay‐for‐performance in New Zealand primary health care; compare this policy development with analogous English initiatives; discuss the risk of unintended, adverse consequences of the New Zealand programme; and consider key lessons for the policy development of pay‐for‐performance in health care.Design/methodology/approachThis article is based on description and analysis of policy developments for performance management in New Zealand and England.FindingsIt is not clear that the New Zealand Programme appropriately reflects the values and goals of primary health care providers. It encourages slow, incremental change by paying bonuses to Primary Health Organisations, rather than practices, for meeting targets on a small number of performance indicators. The bonuses account for a tiny proportion of the total income of PHOs and in general are for service improvement rather than to supplement practitioner incomes. It is important to align performance incentives with stakeholders' values and goals.Originality/valueThe paper discusses New Zealand developments in pay‐for‐performance in the context of English policy initiatives and considers lessons for all health systems.

PurposeThis paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.Design/methodology/approachAnalysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.FindingsOur analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care.Originality/valueThe Israeli case provides an interesting example of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.

Fear is seldom reported in the research literature on barriers to accessing general practitioner (GP) care. One reason may be that some patients are unwilling to admit to fear of this care. This is especially so for patients who, for social, cultural and historical reasons, have a poor sense of self, or do not wish to challenge professionals, or both. In New Zealand, the Maori and Pacific peoples are disproportionately characteristic of these patients and have poor access to GP care, including asthma in children. This paper contributes to the literature on using key informants to interpret another group’s needs, and integrates and adds to known patient attitudes that can hinder access to GP services.

There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary prescribing. Reports elsewhere how a modified Delphi approach, based on the RAND Health Services utilisation study method, was used to produce audit criteria for necessary prescribing for systolic heart failure in New Zealand (NZ) general practice. Reports experience of applying these criteria in late 1999 to the medical notes of a random sample of 70 patients with heart failure, as defined by a recorded diagnosis in 30 practices in central Auckland, NZ. Use of the audit criteria was feasible and appears valid, although the methods used to apply them need to be simplified to be of use as a practical means of promoting clinical governance. The small patient sample demands caution in interpreting the results. However, uncommon yet plausible findings, such as the high frequency of ACE inhibitor prescribing for heart failure, deserve further investigation.