Excellent question, I am very interested in giving you my opinion on the subject, it is not the first time that I answer something like this and I will give you my considerations. I think you should make a difference between health workers (nurses, paramedics and all those related to patients) and administrative workers. I don't see how you can link health workers to a performance payment, that's impossible. You cannot link this group of people to that system, their work based on ethics in patient care has no payment. How would you pay doctors for intensive care in relation to those in the hospital's primary care, there is no way to do it. A doctor, who is a moral doctor, the type of doctor of the Hippocratic Oath can spend several hours without sleeping attending to a patient, that is not paid, there is no way to do it. You would have to develop a complex system of indicators that would not work when it involves intangibles. It is my modest opinion. The other part of those working in a health institution could assess them according to the indicators of attention to medical technologies, the use of expendable materials, medicines, fuels in the transfer of emergencies. They would be similar indicators to those used in other institutions, but even so, the same ethical approaches enter with which it is very difficult to develop indicators. But only in this part of health institutions can indicators be established to pay for results. In any case, all this depends on how you see medicine, if you see it as a business, everything I have written before makes no sense. I see medicine as a public good and the doctor as a priest.