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Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data

Author

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  • Jonathan Sicsic

    (CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse)

  • Carine Franc

    (CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse)

Abstract

Background A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. Objective Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. Methods Based on an administrative database of 50,752 women aged 50–74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). Results Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41–2.35 %)], but the effect was not significantly different following the implementation of the contract. Conclusion The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.

Suggested Citation

  • Jonathan Sicsic & Carine Franc, 2017. "Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(5), pages 609-621, June.
    • Handle: RePEc:spr:eujhec:v:18:y:2017:i:5:d:10.1007_s10198-016-0813-2
    DOI: 10.1007/s10198-016-0813-2
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    Cited by:

    1. Nicolas da Silva, 2021. "The Industrialization of "Liberal Medicine" in France. A Labor Quality Conventions Approach," Post-Print hal-03185634, HAL.
    2. 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.
    3. Sicsic, Jonathan & Krucien, Nicolas & Franc, Carine, 2016. "What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers," Social Science & Medicine, Elsevier, vol. 167(C), pages 116-127.
    4. Nicolas da Silva, 2018. "La médecine libérale entre Sécurité sociale et capitalisme sanitaire : vers une prolétarisation du travail médical ?," Post-Print hal-02306254, HAL.
    5. Mauro, Marianna & Rotundo, Giorgia & Giancotti, Monica, 2019. "Effect of financial incentives on breast, cervical and colorectal cancer screening delivery rates: Results from a systematic literature review," Health Policy, Elsevier, vol. 123(12), pages 1210-1220.

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    More about this item

    Keywords

    Breast cancer screening; Difference-in-difference; Incentives; Pay for performance; Primary care;
    All these keywords.

    JEL classification:

    • C35 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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