In less than 1 decade, the cost of purchasing health care coverage in the United States will equal the mean US household income if current trends continue.1 Learning to deliver high-quality health care at a lower cost is essential for the US system to survive. The article by Wang et al2 in this issue of JAMA Oncology offers evidence from Taiwan that the combination of quality measures and financial incentives can improve the care for breast cancer while also reducing costs. In 2001 the Taiwan government began a voluntary pay-for-performance (PFP) program for breast cancer care that offered bundled payments with bonus incentives for high-quality performance. The authors followed the population of women initiating treatment from 2004 through 2008 and compared their care with that of similar patients treated in the fee-for-service (FFS) population. The results showed improved quality performance confirmed by process measures and outcomes in the PFP group. This is encouraging news, but there are limitations to this study that merit consideration.