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Selection bias in GP fundholding

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  • Darrin L. Baines
  • David K. Whynes

Abstract

This paper uses a logistic regression model based on 1993 data for general practices in a single Family Health Services Authority (Lincolnshire) to analyse the differences in characteristics between existing fundholding (up to and including wave three) and non‐fundholding practices. A high degree of classification accuracy is obtained. Fundholders are revealed to be more likely than non‐fundholders to meet a number of the various quality criteria laid down by central government following the 1990 National Health Services Act, for example, with respect to prescribing cost control, minor surgery and cervical screening uptake. The model is employed to forecast the fourth wave of fundholding and poor predictions suggest the existence of a structural break in the characteristics of fundholders between those in the first three waves and those of wave four. The evidence presented also supports the existence of selection bias in the first three waves of fundholding, although further logistic regression analysis reveals a form of such bias in the fourth wave also.

Suggested Citation

  • Darrin L. Baines & David K. Whynes, 1996. "Selection bias in GP fundholding," Health Economics, John Wiley & Sons, Ltd., vol. 5(2), pages 129-140, March.
    • Handle: RePEc:wly:hlthec:v:5:y:1996:i:2:p:129-140
    DOI: 10.1002/(SICI)1099-1050(199603)5:23.0.CO;2-R
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    References listed on IDEAS

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    1. Javier Salinas-Jimenez & Peter Smith, 1994. "Data envelopment analysis applied to quality in primary health care," Working Papers 124chedp, Centre for Health Economics, University of York.
    2. Tony Scott & Alan Maynard, 1991. "Will the new GP contract lead to cost effective medical practice?," Working Papers 082chedp, Centre for Health Economics, University of York.
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    Cited by:

    1. Giuffrida, Antonio & Gravelle, Hugh & Sutton, Matthew, 2000. "Efficiency and administrative costs in primary care," Journal of Health Economics, Elsevier, vol. 19(6), pages 983-1006, November.
    2. Mark Dusheiko & Maria Goddard & Hugh Gravelle & Rowena Jacobs, 2006. "Trends in health care commissioning in the English NHS: an empirical analysis," Working Papers 011cherp, Centre for Health Economics, University of York.
    3. Laudicella, Mauro & Cookson, Richard & Jones, Andrew M. & Rice, Nigel, 2009. "Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS," Journal of Health Economics, Elsevier, vol. 28(6), pages 1048-1061, December.
    4. Simoens, Steven & Scott, Anthony, 2005. "Voluntary or compulsory health care reform?: The case of primary care organisations in Scotland," Health Policy, Elsevier, vol. 72(3), pages 351-358, June.
    5. Whynes, David K. & Baines, Darrin L., 1998. "Income-based incentives in UK general practice," Health Policy, Elsevier, vol. 43(1), pages 15-31, January.
    6. Dusheiko, Mark & Gravelle, Hugh & Yu, Ning & Campbell, Stephen, 2007. "The impact of budgets for gatekeeping physicians on patient satisfaction: Evidence from fundholding," Journal of Health Economics, Elsevier, vol. 26(4), pages 742-762, July.
    7. Mark Dusheiko & Maria Goddard & Hugh Gravelle & Rowena Jacobs, 2008. "Explaining trends in concentration of healthcare commissioning in the English NHS," Health Economics, John Wiley & Sons, Ltd., vol. 17(8), pages 907-926, August.
    8. Whynes, David K. & Baines, Darrin L., 2002. "Primary care physicians' attitudes to health care reform in England," Health Policy, Elsevier, vol. 60(2), pages 111-132, May.
    9. Mark Dusheiko & Hugh Gravelle & Rowena Jacobs & Peter C Smith, "undated". "The Effect of Budgets on Doctor Behaviour: Evidence From A Natural Experiment," Discussion Papers 03/04, Department of Economics, University of York.
    10. Dusheiko, Mark & Gravelle, Hugh & Jacobs, Rowena & Smith, Peter, 2006. "The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 25(3), pages 449-478, May.
    11. Gravelle, Hugh & Dusheiko, Mark & Sutton, Matthew, 2002. "The demand for elective surgery in a public system: time and money prices in the UK National Health Service," Journal of Health Economics, Elsevier, vol. 21(3), pages 423-449, May.
    12. Karen Bloor & Alan Maynard & Andrew Street, 1999. "The cornerstone of Labour's 'New NHS': reforming primary care," Working Papers 168chedp, Centre for Health Economics, University of York.
    13. Mark Dusheiko & Hugh Gravelle & Rowena Jacobs, 2004. "The effect of practice budgets on patient waiting times: allowing for selection bias," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 941-958, October.

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