IDEAS home Printed from https://ideas.repec.org/
MyIDEAS: Login to save this paper

Economic Incentives in General Practice: the Impact of Pay for Participation Programs on Diabetes Care

  • M. Lippi Bruni
  • L. Nobilio
  • C. Ugolini

Financial incentives are increasingly adopted to improve allocative efficiency and quality in primary care. 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 and on the degree of physicians’ responsiveness to their introduction. This problem reflects the lack of adequate empirical data but also the complexity of general practice systems where many confounding and institutional factors are likely to influence physician behaviour. Given this background, we investigate the impact on quality of care of the introduction of payfor- participation incentives in primary care contracts in the Italian region Emilia Romagna. 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 GPs receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies. To this end, we examined the combined influence of physician, organisational and patient factors through the use of multilevel modelling. Data were obtained form a large dataset made available by the Regional Agency for Health Care Services of Emilia Romagna. This dataset covers patients and GPs of the whole region and provides detailed information on healthcare consumption of the population, on the different components of GP remunerations, on morbidity levels of large groups of patients. Estimations are obtained for the year 2003.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL: http://amsacta.unibo.it/4666/1/607.pdf
Download Restriction: no

Paper provided by Dipartimento Scienze Economiche, Universita' di Bologna in its series Working Papers with number 607.

as
in new window

Length:
Date of creation: Sep 2007
Date of revision:
Handle: RePEc:bol:bodewp:607
Contact details of provider: Postal:
Piazza Scaravilli, 2, and Strada Maggiore, 45, 40125 Bologna

Phone: +39 051 209 8019 and 2600
Fax: +39 051 209 8040 and 2664
Web page: http://www.dse.unibo.it

More information through EDIRC

References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

as in new window
  1. 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.
  2. Scott, Anthony & Hall, Jane, 1995. "Evaluating the effects of GP remuneration: problems and prospects," Health Policy, Elsevier, vol. 31(3), pages 183-195, March.
  3. Canice Prendergast, 1999. "The Provision of Incentives in Firms," Journal of Economic Literature, American Economic Association, vol. 37(1), pages 7-63, March.
  4. Beaulieu Nancy & Cutler David M & Ho Katherine & Isham George & Lindquist Tammie & Nelson Andrew & O'Connor Patrick, 2006. "The Business Case for Diabetes Disease Management for Managed Care Organizations," Forum for Health Economics & Policy, De Gruyter, vol. 9(1), pages 1-38, December.
  5. Frey, Bruno S., 1993. "Shirking or work morale? : The impact of regulating," European Economic Review, Elsevier, vol. 37(8), pages 1523-1532, December.
  6. Eggleston, Karen, 2005. "Multitasking and mixed systems for provider payment," Journal of Health Economics, Elsevier, vol. 24(1), pages 211-223, January.
  7. Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
  8. 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.
  9. Bruno S. Frey & Reto Jegen, 2000. "Motivation Crowding Theory: A Survey of Empirical Evidence," CESifo Working Paper Series 245, CESifo Group Munich.
  10. 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.
  11. Davis, Peter & Gribben, Barry & Scott, Alastair & Lay-Yee, Roy, 2000. "The "supply hypothesis" and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation," Social Science & Medicine, Elsevier, vol. 50(3), pages 407-418, February.
  12. 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.
  13. George A. Akerlof, 1980. "A Theory of Social Custom, of which Unemployment may be One Consequence," The Quarterly Journal of Economics, Oxford University Press, vol. 94(4), pages 749-775.
  14. 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.
  15. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575.
  16. Whynes, David K. & Baines, Darrin L., 1998. "Income-based incentives in UK general practice," Health Policy, Elsevier, vol. 43(1), pages 15-31, January.
  17. 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.
Full references (including those not matched with items on IDEAS)

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:bol:bodewp:607. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Task Force CeSIA DSE)

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.