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An Incentive Program with Almost no Incentive: Overlooked Benefits of Pay for Performance

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  • Chunzhou Mu
  • Shiko Maruyama

Abstract

Australia introduced the Service Incentive Payment (SIP) program for diabetes in 2001, which offers a trivial financial reward to general practitioners (GPs). We estimate the effect of the diabetes SIP on a wide range of healthcare utilisations of diabetes patients, with the aim of evaluating a pay‐for‐performance program more comprehensively than existing research. Using a large survey linked to administrative medical claims data, we compare a wide range of healthcare utilisation outcomes between areas with high SIP penetration and low SIP penetration. To uncover causal effects, we conduct a difference‐in‐differences analysis, which employs GPs who are ineligible for claiming a SIP reward as a control group. We find that concessional diabetes patients (who face low cost‐sharing and hence tend to use more services than the socially optimal level) in high‐SIP‐penetration areas tend to use less healthcare compared to those in low‐SIP‐penetration areas. Conversely, non‐concessional patients in high‐SIP‐penetration areas tend to use more healthcare than their counterparts in low‐SIP‐penetration areas. No compromise on health is observed, implying that despite the minor reward, the SIP program has improved systematic diabetes management and consequently enhanced social efficiency by nudging GPs.

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  • Chunzhou Mu & Shiko Maruyama, 2024. "An Incentive Program with Almost no Incentive: Overlooked Benefits of Pay for Performance," The Economic Record, The Economic Society of Australia, vol. 100(331), pages 491-512, December.
    • Handle: RePEc:bla:ecorec:v:100:y:2024:i:331:p:491-512
    DOI: 10.1111/1475-4932.12828
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    1. Richard Hornbeck, 2010. "Barbed Wire: Property Rights and Agricultural Development," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(2), pages 767-810.
    2. Uri Gneezy & Stephan Meier & Pedro Rey-Biel, 2011. "When and Why Incentives (Don't) Work to Modify Behavior," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 191-210, Fall.
    3. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    4. Erin M. Johnson & M. Marit Rehavi, 2016. "Physicians Treating Physicians: Information and Incentives in Childbirth," American Economic Journal: Economic Policy, American Economic Association, vol. 8(1), pages 115-141, February.
    5. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
    6. Raj Chetty & John N. Friedman & Emmanuel Saez, 2013. "Using Differences in Knowledge across Neighborhoods to Uncover the Impacts of the EITC on Earnings," American Economic Review, American Economic Association, vol. 103(7), pages 2683-2721, December.
    7. Toshiaki Iizuka, 2007. "Experts' agency problems: evidence from the prescription drug market in Japan," RAND Journal of Economics, RAND Corporation, vol. 38(3), pages 844-862, September.
    8. Matt Sutton & Ross Elder & Bruce Guthrie & Graham Watt, 2010. "Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 1-13, January.
    9. Amitabh Chandra & Douglas O Staiger, 2020. "Identifying Sources of Inefficiency in Healthcare [“The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care,”]," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 135(2), pages 785-843.
    10. Meliyanni Johar & Chunzhou Mu & Kees Van Gool & Chun Yee Wong, 2017. "Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 528-535, April.
    11. Duarte, Fabian, 2012. "Price elasticity of expenditure across health care services," Journal of Health Economics, Elsevier, vol. 31(6), pages 824-841.
    12. Karinna Saxby & Joshua Byrnes & Sonja C. de New & Son Nghiem & Dennis Petrie, 2023. "Does affirmative action reduce disparities in healthcare use by Indigenous peoples? Evidence from Australia's Indigenous Practice Incentives Program," Health Economics, John Wiley & Sons, Ltd., vol. 32(4), pages 853-872, April.
    13. Jason Abaluck & Leila Agha & Chris Kabrhel & Ali Raja & Arjun Venkatesh, 2016. "The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care," American Economic Review, American Economic Association, vol. 106(12), pages 3730-3764, December.
    14. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2009. "The effects of an incentive program on quality of care in diabetes management," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1091-1108, September.
    15. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    16. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    17. Tatiana A. Homonoff, 2018. "Can Small Incentives Have Large Effects? The Impact of Taxes versus Bonuses on Disposable Bag Use," American Economic Journal: Economic Policy, American Economic Association, vol. 10(4), pages 177-210, November.
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