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In most Western health care systems, producing high-quality care efficiently is not rewarded by higher revenues. ‘Pay for performance’ schemes have emerged, rewarding improved performance of providers through financial incentives, but these schemes are simply overlaid on systems that are flawed [1,2]. In this editorial, we discuss a system with patients and providers in the leading roles, not imposing impossible burdens on patients, which induces providers to take the lead in providing high-quality care efficiently. The system would not rely on health plans or insurance companies contracting care for patients. In this system, patients themselves would ‘shop’ for their care, being guided by a system of ‘smart’ copays.Such a market set-up requires regulation to ensure the desired outcomes: timely, effective, safe, patient-oriented, affordable care. Here, we only discuss the model’s outlines.Four issues are paramount to such a system. First, equal access to a basic package of health care services that encompasses all ‘necessary’ care is essential (e.g. through an obligatory system of health insurance). Through regulation, risk-selection should be mitigated, or an adequate insurance pool to ensure equal access should be created. For systems that see ‘solidarity’ as a basic value, ensuring equity in this way is fundamental [3].Second, competition should be organized around the integrated care for a patient’s disease or condition [4]. This care product (such as ‘diabetes care’) should ideally include all activities and materials that are part of the handling of this care: tests, hospital stay, physicians’ fees, home care, medication, and any complications that might occur as a result of the care received by the patient. This aligns with the Diagnosis Related Group (DRG)-like payment systems many countries have opted for.Often, a single organization will not be able to offer all components of …

The right incentives for high-quality, affordable care: a new form of regulated competition