It is important to keep in mind these sorts of unintended consequences of pay for performance implementation. A third and final issue with the pay for performance model is the fact that it will increase administrative costs.  Rather than paying providers on a salaried basis, the setting of performance targets means there will need to be follow-up to ensure services provided are not inflated and there is a new built in payment system that requires more staff.  While this shouldn't discourage a country from implementing a pay for performance model, it must be considered early on, as healthcare spending will likely increase.