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The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada


  • Thaksha Thavam

    (University of Western Ontario)

  • Rose Anne Devlin

    (University of Ottawa)

  • Amardeep Thind

    (University of Western Ontario)

  • Gregory S. Zaric

    (University of Western Ontario
    University of Western Ontario)

  • Sisira Sarma

    (University of Western Ontario


Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario. Longitudinal health administrative data were obtained for adults diagnosed with diabetes and their family physicians. The study population consisted of two groups: DMI group (patients enrolled with a family physician exposed to DMI for 3 years), and comparison group (patients affiliated with a family physician ineligible for DMI throughout the study period). Diabetes-related services was measured using the Diabetic Management Assessment (DMA) billing code claimed by patient’s physician. The impact of DMI on diabetes-related services was assessed using difference-in-differences regression models. After adjusting for patient- and physician-level characteristics, patient fixed-effects and patient-specific time trend, we found that DMI increased the probability of having at least one DMA fee code claimed by patient’s physician by 9.3% points, and the probability of having at least three DMA fee codes claimed by 2.1% points. Subgroup analyses revealed the impact of DMI was slightly larger in males compared to females. We found that Ontario’s DMI was effective in increasing the diabetes-related services provided to patients diagnosed with diabetes in Ontario. Financial incentives for physicians help improve the provision of targeted diabetes-related services.

Suggested Citation

  • Thaksha Thavam & Rose Anne Devlin & Amardeep Thind & Gregory S. Zaric & Sisira Sarma, 2020. "The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1279-1293, December.
  • Handle: RePEc:spr:eujhec:v:21:y:2020:i:9:d:10.1007_s10198-020-01216-6
    DOI: 10.1007/s10198-020-01216-6

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    References listed on IDEAS

    1. Jasmin Kantarevic & Boris Kralj, 2013. "Link Between Pay For Performance Incentives And Physician Payment Mechanisms: Evidence From The Diabetes Management Incentive In Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1417-1439, December.
    2. Lippi Bruni, Matteo & Nobilio, Lucia & Ugolini, Cristina, 2009. "Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care," Health Policy, Elsevier, vol. 90(2-3), pages 140-148, May.
    3. Jinhu Li & Jeremiah Hurley & Philip DeCicca & Gioia Buckley, 2014. "Physician Response To Pay‐For‐Performance: Evidence From A Natural Experiment," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 962-978, August.
    4. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    5. Lin, Tzu-Yu & Chen, Chia-Yu & Huang, Yu Tang & Ting, Ming-Kuo & Huang, Jui-Chu & Hsu, Kuang-Hung, 2016. "The effectiveness of a pay for performance program on diabetes care in Taiwan: A nationwide population-based longitudinal study," Health Policy, Elsevier, vol. 120(11), pages 1313-1321.
    6. Lavergne, M. Ruth & Law, Michael R. & Peterson, Sandra & Garrison, Scott & Hurley, Jeremiah & Cheng, Lucy & McGrail, Kimberlyn, 2018. "Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis," Health Policy, Elsevier, vol. 122(2), pages 157-164.
    7. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2009. "The effects of an incentive program on quality of care in diabetes management," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1091-1108, September.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 9th November 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-11-09 12:00:00

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    More about this item


    Diabetes management; Financial incentive; Primary care physician; Ontario; Canada;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • C33 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Models with Panel Data; Spatio-temporal Models


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