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Incentives in primary care and their impact on potentially avoidable hospital admissions

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  • Gianluca Fiorentini
  • Elisa Iezzi
  • Matteo Lippi Bruni
  • Cristina Ugolini

Abstract

Financial incentives in primary care have been often introduced with the purpose of improvingappropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives have been also implemented, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines. Here, we assess the influence of different programs which ensure extra-payments to GPs, for containing episodes of avoidable hospitalisations. Our dataset covers patients and GPs of the Italian region Emilia-Romagna for year 2005, and we control for a wide range of factors potentially influencing GPs behaviour. By separating pay-for-performance from pay-for-participation and pay-for-compliance programs, we estimate the impact on the probability of (inappropriate) hospitalisation of financial incentives included in contracts between GPs and the NHS. As dependent variable, we consider two different sets of conditions, for both of which timely and effective primary care should be able to limit the need of hospital admission. The first is based on 27 medical DRGs that Emilia-Romagna identifies as at risk of inappropriateness in primary care, while the second refers to the internationally recognised ACSCs (ambulatory care-sensitive conditions). We show that pay-for-performance schemes may have a significant effect over aggregate indicators of appropriateness, while the effectiveness of pay-for-participation schemes is adequately captured only by taking into account subpopulations affected by specific diseases. Moreover, the same incentive scheme has fairly different effects on the two sets of indicators used, with performance improvements limited to the target explicitly addressed by the policy maker (i.e. the list of 27 DRGs). This evidence is consistent with the idea that a tunnel vision effect may occur when public authorities promote and monitor specific sets of objectives, as proxies for more general improvements in health care pract
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  • Gianluca Fiorentini & Elisa Iezzi & Matteo Lippi Bruni & Cristina Ugolini, 2011. "Incentives in primary care and their impact on potentially avoidable hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 297-309, August.
    • Handle: RePEc:spr:eujhec:v:12:y:2011:i:4:p:297-309
    DOI: 10.1007/s10198-010-0230-x
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    1. Ugolini, Cristina & Lippi Bruni, Matteo & Leucci, Anna Caterina & Fiorentini, Gianluca & Berti, Elena & Nobilio, Lucia & Moro, Maria Luisa, 2019. "Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes," Health Policy, Elsevier, vol. 123(10), pages 955-962.
    2. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
    3. Matteo Lippi Bruni & Irene Mammi, 2017. "Spatial effects in hospital expenditures: A district level analysis," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 63-77, September.
    4. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    5. Donatini A. & Fiorentini G. & Lippi Bruni M. & Mammi I. & Ugolini C., 2014. "Dealing with minor illnesses: the link between primary care characteristics and First Aid Clinics attendances," Working Papers wp925, Dipartimento Scienze Economiche, Universita' di Bologna.
    6. Monica Giancotti & Giorgia Rotundo & Paolo Misericordia & Silvestro Scotti & Milena Lopreite & Marianna Mauro, 2018. "Preliminary investigation into general practitioners? willingness to accept the pay-for-performance scheme: A replication study," MECOSAN, FrancoAngeli Editore, vol. 2018(106), pages 65-92.
    7. L. F. Andrade & T. Rapp & C. Sevilla-Dedieu, 2018. "Quality of diabetes follow-up care and hospital admissions," International Journal of Health Economics and Management, Springer, vol. 18(2), pages 153-167, June.
    8. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    9. Dimitrovová, Klára & Perelman, Julian & Serrano-Alarcón, Manuel, 2020. "Effect of a national primary care reform on avoidable hospital admissions (2000–2015): A difference-in-difference analysis," Social Science & Medicine, Elsevier, vol. 252(C).
    10. Ammi, Mehdi & Fortier, Grant, 2017. "The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review," Social Science & Medicine, Elsevier, vol. 178(C), pages 157-166.
    11. Pedersen, Line Bjørnskov & Andersen, Merethe Kirstine Kousgaard & Jensen, Ulrich Thy & Waldorff, Frans Boch & Jacobsen, Christian Bøtcher, 2018. "Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark," Social Science & Medicine, Elsevier, vol. 211(C), pages 224-233.
    12. Lin, Tracy Kuo & Werner, Kalin & Witter, Sophie & Alluhidan, Mohammed & Alghaith, Taghred & Hamza, Mariam M. & Herbst, Christopher H. & Alazemi, Nahar, 2022. "Individual performance-based incentives for health care workers in Organisation for Economic Co-operation and Development member countries: a systematic literature review," Health Policy, Elsevier, vol. 126(6), pages 512-521.
    13. Shen, Menghan & He, Wen & Li, Linyan, 2020. "Incentives to use primary care and their impact on healthcare utilization: Evidence using a public health insurance dataset in China," Social Science & Medicine, Elsevier, vol. 255(C).
    14. Visca, Modesta & Donatini, Andrea & Gini, Rosa & Federico, Bruno & Damiani, Gianfranco & Francesconi, Paolo & Grilli, Leonardo & Rampichini, Carla & Lapini, Gabriele & Zocchetti, Carlo & Di Stanislao,, 2013. "Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs," Health Policy, Elsevier, vol. 113(1), pages 188-198.
    15. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.
    16. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
    17. Ugolini, Cristina & Lippi Bruni, Matteo & Mammi, Irene & Donatini, Andrea & Fiorentini, Gianluca, 2016. "Dealing with minor illnesses: The link between primary care characteristics and Walk-in Centres’ attendances," Health Policy, Elsevier, vol. 120(1), pages 72-80.

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    More about this item

    Keywords

    Primary care; Preventable hospitalisation; Financial incentive; Organizational appropriateness; Multilevel modelling; I11; I18; C31;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models

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