Pay for performance so far has been only a stopgap measure to fix the fundamentally broken payment system, according to a report issued by PricewaterhouseCoopers' Health Research Institute. The organization found that there is little quantifiable effect on health care quality, outcomes, and efficiency and there are insufficient financial incentives to change physician behavior. Findings were based on in-depth interviews with top executives of 10 of the nation's largest commercial payers.... The underinsured account for 24 percent of the United States population, according to a survey in Consumer Reports. This population lives with health coverage that barely covers medical needs, and leaves them unprepared to pay for medical expenses. Forty-nine percent of people overall, and 43 percent of people with insurance, said they were "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year.... Communicating with employees is the greatest challenge employers face when introducing a consumer-directed health plan, according to the consulting firm Watson Wyatt. The sparse information about provider cost and quality is another obstacle that hampers consumer-directed health care acceptance. A study jointly conducted with Rand showed that specific resources needed to help workers evaluate the cost and quality of care are often lacking. Just 2 percent rated cost information about providers as "excellent" and only 5 percent rated it as "good."