In many ways, this payment structure, when used in an intelligent manner, can increase health outcomes and increase health access.  When performance incentives are set up to measure outcomes, say the percentage of HIV-positive patients put on anti-retroviral therapy, increased health status should be a clear outcome.  This also adds to efficiency, as performance targets can be set to reward providers who provide low-cost, high effectiveness treatments and interventions.  Preventative care and screening, say HIV testing during regular checkups, can also add to efficiency, as HIV testing and screening has been shown to be a cost-effective intervention by the CDC.  In addition, for performance-based measures, physicians often have incentives to provide certain services to as much of the population as possible.