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Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities

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  • Christophe Loussouarn
  • Carine Franc
  • Yann Videau
  • Julien Mousquès

Abstract

The integration of primary care organizations and interprofessional cooperation is encouraged in many countries to both improve the productive and allocative efficiency of care provision and address the unequal geographical distribution of general practitioners (GPs). In France, a pilot experiment promoted the vertical integration of and teamwork between GPs and nurses. This pilot experiment relied on the staffing and training of nurses; skill mixing, including the authorization to shift tasks from GPs to nurses; and new remuneration schemes. This article evaluates the overall impact of this pilot experiment over the period 2010–2017 on GP activities based on the following indicators: number of working days, patients seen at least once, patients registered, and visits delivered. We control for endogeneity and reduce selection bias by using a case‐control design combining coarsened exact matching and difference‐in‐differences estimates on panel data. We find a small positive impact on the number of GP working days (+1.2%) following enrollment and a more pronounced effect on the number of patients seen (+7.55%) or registered (+6.87%). However, we find no effect on the number of office and home visits. In this context, cooperation and teamwork between GPs and nurses seem to improve access to care for patients.

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  • Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2021. "Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 680-698, March.
    • Handle: RePEc:wly:hlthec:v:30:y:2021:i:3:p:680-698
    DOI: 10.1002/hec.4214
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    1. Alchian, Armen A & Demsetz, Harold, 1972. "Production , Information Costs, and Economic Organization," American Economic Review, American Economic Association, vol. 62(5), pages 777-795, December.
    2. Dumontet, Magali & Buchmueller, Thomas & Dourgnon, Paul & Jusot, Florence & Wittwer, Jérôme, 2017. "Gatekeeping and the utilization of physician services in France: Evidence on the Médecin traitant reform," Health Policy, Elsevier, vol. 121(6), pages 675-682.
    3. James J. Heckman & Hidehiko Ichimura & Petra E. Todd, 1997. "Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 605-654.
    4. Aghion, Philippe & Tirole, Jean, 1997. "Formal and Real Authority in Organizations," Journal of Political Economy, University of Chicago Press, vol. 105(1), pages 1-29, February.
    5. Canice Prendergast, 1999. "The Provision of Incentives in Firms," Journal of Economic Literature, American Economic Association, vol. 37(1), pages 7-63, March.
    6. Edward P. Lazear & Kathryn L. Shaw, 2007. "Personnel Economics: The Economist's View of Human Resources," Journal of Economic Perspectives, American Economic Association, vol. 21(4), pages 91-114, Fall.
    7. repec:ner:ucllon:http://discovery.ucl.ac.uk/17678/ is not listed on IDEAS
    8. Tsiachristas, A. & Wallenburg, I. & Bond, C.M. & Elliot, R.F. & Busse, R. & van Exel, J. & Rutten-van Mölken, M.P. & de Bont, A., 2015. "Costs and effects of new professional roles: Evidence from a literature review," Health Policy, Elsevier, vol. 119(9), pages 1176-1187.
    9. Groenewegen, Peter & Heinemann, Stephanie & Greß, Stefan & Schäfer, Willemijn, 2015. "Primary care practice composition in 34 countries," Health Policy, Elsevier, vol. 119(12), pages 1576-1583.
    10. Barton H. Hamilton & Jack A. Nickerson & Hideo Owan, 2003. "Team Incentives and Worker Heterogeneity: An Empirical Analysis of the Impact of Teams on Productivity and Participation," Journal of Political Economy, University of Chicago Press, vol. 111(3), pages 465-497, June.
    11. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 1-19.
    12. King, Gary & Nielsen, Richard, 2019. "Why Propensity Scores Should Not Be Used for Matching," Political Analysis, Cambridge University Press, vol. 27(4), pages 435-454, October.
    13. Kim Olsen & Dorte Gyrd-Hansen & Torben Sørensen & Troels Kristensen & Peter Vedsted & Andrew Street, 2013. "Organisational determinants of production and efficiency in general practice: a population-based study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 267-276, April.
    14. Julien Silhol & Bruno Ventelou & Anna Zaytseva & Claire Marbot, 2019. "Comportements et pratiques des médecins : exercer dans les zones les moins dotées, cela fait-il une différence ?," Post-Print hal-02475133, HAL.
    15. Iacus, Stefano M. & King, Gary & Porro, Giuseppe, 2012. "Causal Inference without Balance Checking: Coarsened Exact Matching," Political Analysis, Cambridge University Press, vol. 20(1), pages 1-24, January.
    16. Strumpf, Erin & Ammi, Mehdi & Diop, Mamadou & Fiset-Laniel, Julie & Tousignant, Pierre, 2017. "The impact of team-based primary care on health care services utilization and costs: Quebec’s family medicine groups," Journal of Health Economics, Elsevier, vol. 55(C), pages 76-94.
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    1. Chris Sampson’s journal round-up for 8th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-08 12:00:01

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    1. Anna Zaytseva & Pierre Verger & Bruno Ventelou, 2021. "United, we can be stronger! French integrated general practitioners had better chronic care follow-up during lockdown," AMSE Working Papers 2132, Aix-Marseille School of Economics, France.
    2. Line Planck Kongstad & Nicolai Damslund & Jens Søndergaard & Geir Godager & Kim Rose Olsen, 2025. "Do Physicians Respond to Additional Capitation Payments in Mixed Remuneration Schemes?," Health Economics, John Wiley & Sons, Ltd., vol. 34(6), pages 1143-1159, June.
    3. Vanessa Ress & Eva‐Maria Wild, 2024. "The impact of integrated care on health care utilization and costs in a socially deprived urban area in Germany: A difference‐in‐differences approach within an event‐study framework," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 229-247, February.

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