The link between paying incentives and improving quality in healthcare remains largely theoretical in Canada - and, indeed, around the world. Evidence that tying pay or funding to good results will improve care is inconsistent and often weak. Yet "pay for performance" and "service-based funding" are fast-growing international trends, rapidly becoming dominant models in American and British healthcare. Now they're making inroads in Canada and are unquestionably headed for a bigger role in years to come.