Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care
Objectives We investigate the impact on quality of care of the introduction of two financial incentives in primary care contracts in the Italian region Emilia Romagna: pay-for-participation and pay-for-compliance with best practices programs.Methods We concentrate on patients affected by diabetes mellitus type 2, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We test the hypothesis that, other things equal, patients under the responsibility of general practitioners (GPs) receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies. To this end, we examine the combined influence of physician, organisational and patient factors by means of multilevel modelling for the year 2003.Results Programs aimed at stimulating GP assumption of responsibility in disease management significantly reduce the probability of hyperglycaemic emergencies for their patients.Conclusions Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence healthcare outcomes. Our results support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.
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- Hugh Gravelle & Giuliano Masiero, "undated".
"Quality incentives in a regulated market with imperfect information and switching costs: capitation in general practice,"
00/18, Department of Economics, University of York.
- Gravelle, Hugh & Masiero, Giuliano, 2000. "Quality incentives in a regulated market with imperfect information and switching costs: capitation in general practice," Journal of Health Economics, Elsevier, vol. 19(6), pages 1067-1088, November.
- Whynes, David K. & Baines, Darrin L., 1998. "Income-based incentives in UK general practice," Health Policy, Elsevier, vol. 43(1), pages 15-31, January.
- Hughes, David & Yule, Brian, 1992. "The effect of per-item fees on the behaviour of general practitioners," Journal of Health Economics, Elsevier, vol. 11(4), pages 413-437, December.
- Scott, Anthony & Shiell, Alan, 1997. "Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model," Journal of Health Economics, Elsevier, vol. 16(3), pages 323-342, June.
- Wennberg, John E. & Barnes, Benjamin A. & Zubkoff, Michael, 1982. "Professional uncertainty and the problem of supplier-induced demand," Social Science & Medicine, Elsevier, vol. 16(7), pages 811-824, January.
- Scott, A & Schurer, S & Jensen, P H & Sivey, P, 2008.
"The Effects of Financial Incentives on Quality of Care: The Case of Diabetes,"
Health, Econometrics and Data Group (HEDG) Working Papers
08/15, HEDG, c/o Department of Economics, University of York.
- Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2008. "The Effect of Financial Incentives on Quality of Care: The Case of Diabetes," Melbourne Institute Working Paper Series wp2008n12, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
- Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575.
- Kristiansen, Ivar S. & Mooney, Gavin, 1993. "Remuneration of GP services: time for more explicit objectives? A review of the systems in five industrialised countries," Health Policy, Elsevier, vol. 24(3), pages 203-212, August.
- Holmstrom, Bengt & Milgrom, Paul, 1991. "Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design," Journal of Law, Economics and Organization, Oxford University Press, vol. 7(0), pages 24-52, Special I.
- Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
- W. J. Browne & S. V. Subramanian & K. Jones & H. Goldstein, 2005. "Variance partitioning in multilevel logistic models that exhibit overdispersion," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(3), pages 599-613.
- Mooney, Gavin & Ryan, Mandy, 1993. "Agency in health care: Getting beyond first principles," Journal of Health Economics, Elsevier, vol. 12(2), pages 125-135, July.
- Eggleston, Karen, 2005. "Multitasking and mixed systems for provider payment," Journal of Health Economics, Elsevier, vol. 24(1), pages 211-223, January.
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