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General practitioners’ income and activity: the impact of multi-professional group practice in France

Author

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  • Matthieu Cassou

    (CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres)

  • Julien Mousquès

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres)

  • Carine Franc

    (CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres)

Abstract

France has first experimented, in 2009, and then generalized a practice level add-on payment to promote Multi-Professional Primary Care Groups (MPCGs). Team-based practices are intended to improve both the efficiency of outpatient care supply and the attractiveness of medically underserved areas for healthcare professionals. To evaluate its financial attractiveness and thus the sustainability of MPCGs, we analyzed the evolution of incomes (self-employed income and wages) of General Practitioners (GPs) enrolled in a MPCG, compared with other GPs. We also studied the impacts of working in a MPCG on GPs' activity through both the quantity of medical services provided and the number of patients encountered. Our analyses were based on a quasi-experimental design, with a panel dataset over the period 2008–2014. We accounted for the selection into MPCG by using together coarsened exact matching and difference-in-differences (DID) design with panel-data regression models to account for unobserved heterogeneity. We show that GPs enrolled in MPCGs during the period exhibited an increase in income 2.5% higher than that of other GPs; there was a greater increase in the number of patients seen by the GPs' (88 more) without involving a greater increase in the quantity of medical services provided. A complementary cross-sectional analysis for 2014 showed that these changes were not detrimental to quality in terms of bonuses related to the French pay-for-performance program for the year 2014. Hence, our results suggest that labor and income concerns should not be a barrier to the development of MPCGs, and that MPCGs may improve patient access to primary care services.

Suggested Citation

  • Matthieu Cassou & Julien Mousquès & Carine Franc, 2020. "General practitioners’ income and activity: the impact of multi-professional group practice in France," Post-Print hal-03109158, HAL.
    • Handle: RePEc:hal:journl:hal-03109158
    DOI: 10.1007/s10198-020-01226-4
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    References listed on IDEAS

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    Blog mentions

    As found by EconAcademics.org, 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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    Cited by:

    1. Anna Zaytseva & Pierre Verger & Bruno Ventelou, 2023. "Better together? A mediation analysis of general practitioners' performance in multi-professional group practice," AMSE Working Papers 2325, Aix-Marseille School of Economics, France.
    2. Christophe Loussouarn, 2022. "Effets des modes de rémunération et d’organisation des soins sur l’activité des médecins généralistes libéraux en France," Erudite Ph.D Dissertations, Erudite, number ph22-02 edited by Yann Videau & Julien Mousquès, December.
    3. Constantinou, Panayotis & Tuppin, Philippe & Gastaldi-Ménager, Christelle & Pelletier-Fleury, Nathalie, 2022. "Defining a risk-adjustment formula for the introduction of population-based payments for primary care in France," Health Policy, Elsevier, vol. 126(9), pages 915-924.

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    More about this item

    Keywords

    Difference-in-differences; General practitioner; Income; Primary care; Teamwork;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • C21 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models

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