A study published in the Archives of Internal Medicine finds that per capita Medicare spending on the elderly has grown nearly three times faster in the United States than in Canada since 1980.

Canada’s program, which covers all Canadians, not just the elderly, is also called Medicare. Cost grew more slowly in Canada despite a 1984 law banning co-payments and deductibles.

A leading authority on behavioral economics has teamed up with two health policy experts in an article at the Health Affairs blog to argue that pay-for-performance (P4P) schemes in medicine may do more harm than good by “crowding out” altruism and other intrinsic motivations to do a good job.