The Role of GP’s Compensation Schemes in Diabetes Care: Evidence from Panel Data

Abstract

The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. 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 health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to 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 avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

Spatial effects in hospital expenditures: A district level analysis

“…Community and primary care policies are characterised by large heterogeneity across districts. Local programs may promote the achievement of specific health policy targets, including disease management for chronic conditions or postacute follow‐up (Iezzi, Lippi Bruni, & Ugolini, ).…”

The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach

“…In England, for instance, two health policies have been the subject of numerous evaluation studies: the Quality and Outcome Framework introduced financial incentives to improve disease management in PC preventing use of ESC for patients with chronic conditions (Dusheiko et al, 2011; Oxholm et al, 2018); the Equitable Access to Primary Medical Care increased accessibility of PC services by extending opening hours and opening new walk‐in centres in selected areas of the country (Dolton & Pathania, 2016; Pinchbeck, 2019). Similar policies have been implemented in other countries in the EU (Iezzi et al, 2014; OECD/WHO, 2019).…”

“…To deal with these issues, existing empirical applications make use of the exogenous variation in the supply of PC induced by a policy reform over time and across geographical areas. Then, they measure the substitution effect at the level of the GP practice or small geographical area by using a linear panel data model (Dolton & Pathania, 2016; Dusheiko et al, 2011; Fortney et al, 2005; Pinchbeck, 2019; Whittaker et al, 2016) or a Poisson model (Iezzi et al, 2014; Lippi Bruni et al, 2016) and a difference in differences approach, which is corroborated by a propensity score matching or an instrumental variable approach in some applications. These studies find evidence of a substitution effect at the GP practice level, although the patient level substitution effect might be different due to ecological fallacy, and the effect in the total population might be different from the effect in areas targeted by the policy.…”

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

“…This fundamental dimension of quality of care may depend on the remuneration scheme. The literature shows that patients enrolled in a pay‐for‐performance (P4P) program undergo significantly more diabetes‐specific examinations and tests after enrollment ( Cheng, Lee, & Chen, ; Iezzi, Lippi Bruni, & Ugolini, ; Scott, Schurer, Jensen, & Sivey, ; Simcoe, Catillon, & Gertler, ). Although a P4P program may have a positive impact, such as a reduction in emergency admissions ( Van der Pol et al, ) , the efficiency of such programs seems heterogeneous.…”