“…Frequently, health care professionals have described monitoring of quality measures for external accountability as an administrative burden with limited benefits, arguing that such use limits their professional autonomy and motivation (McDonald and Roland, 2009; Young et al ., 2017) and contributes to burnout (Bodenheimer and Sinsky, 2014). Reviews of empirical studies suggest that quality-based competition have had a limited effect on the quality of care (Fotaki, 2020; Van Ginneken et al ., 2020). Likewise, P4P schemes usually have limited effects on process measures and no effect on outcome measures (Van Herck et al ., 2010; Scott et al ., 2011; Eijkenaar et al ., 2013; Ogundeji et al ., 2016; Ellegård et al ., 2018).…”