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Healthcare Quality by Specialists under a Mixed Compensation System: an Empirical Analysis

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  • Damien Échevin
  • Bernard Fortin
  • Aristide Houndetoungan

Abstract

We analyze the effects of a mixed compensation (MC) scheme for specialists on the quality of their healthcare services. To do so, we exploit a major reform that was implemented in Quebec (Canada) in 1999. The government introduced a payment mechanism combining a fixed per diem with a reduced fee per clinical service. Using panel patient-doctor data covering the period 1996-2016 and including 320,441 patients, we estimate a multi-state multi-spell hazard model with correlated heterogeneity, analogous to a difference-in-differences approach. We compute three output-based quality indicators from our model. Our results suggest that the reform reduced the quality of MC specialist services as measured by the risk of re-hospitalization within 30 days after discharge and the risk of mortality within one year after discharge. These effects vary depending upon the specialty of the treating doctor. Nous analysons les effets d'un mode de rémunération mixte pour les médecins sur la qualité de leurs services cliniques. Pour ce faire, nous exploitons une réforme majeure mise en œuvre au Québec en 1999. Le gouvernement du Québec a introduit un mode de rémunération mixte combinant un per diem fixe et des tarifs à l'acte réduits pour le médecins spécialistes travaillant en établissement. En utilisant des données administratives panel patient-médecin couvrant la période 1996-2016 et incluant 320 441 patients, nous estimons un modèle de risque multi-état multi-épisode avec hétérogénéité corrélée au niveau individuel, analogue à une approche de différence en différences. Nous calculons trois indicateurs de qualité de services cliniques à partir de notre modèle. Nos résultats suggèrent que la réforme a réduit la qualité des services des médecins spécialistes en rémunération mixte, telle que mesurée par le risque de ré-hospitalisation dans les 30 jours suivant la sortie de l'hôpital du patient et le risque de mortalité dans l'année suivant la sortie de l'hôpital du patient. Ces effets varient en fonction de la spécialité du médecin traitant.

Suggested Citation

  • Damien Échevin & Bernard Fortin & Aristide Houndetoungan, 2023. "Healthcare Quality by Specialists under a Mixed Compensation System: an Empirical Analysis," CIRANO Working Papers 2023s-19, CIRANO.
    • Handle: RePEc:cir:cirwor:2023s-19
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    File URL: https://cirano.qc.ca/files/publications/2023s-19.pdf
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    More about this item

    Keywords

    Mixed compensation; Quality of medical services; Hospital length-ofstay; Risk of re-hospitalization; Risk of death; Hazard model; Natural experiment; Rémunération mixte; Qualité des services médicaux; Durée du séjour à l'hôpital; Risque de ré-hospitalisation; Risque de décès; Modèle des risques; Expérience naturelle;
    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
    • C41 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Duration Analysis; Optimal Timing Strategies

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