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Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care

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  • Lippi Bruni, Matteo
  • Nobilio, Lucia
  • Ugolini, Cristina

Abstract

Objectives We investigate the impact on quality of care of the introduction of two financial incentives in primary care contracts in the Italian region Emilia Romagna: pay-for-participation and pay-for-compliance with best practices programs.Methods 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 general practitioners (GPs) receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies. To this end, we examine the combined influence of physician, organisational and patient factors by means of multilevel modelling for the year 2003.Results Programs aimed at stimulating GP assumption of responsibility in disease management significantly reduce the probability of hyperglycaemic emergencies for their patients.Conclusions 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. Our results 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.

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  • Lippi Bruni, Matteo & Nobilio, Lucia & Ugolini, Cristina, 2009. "Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care," Health Policy, Elsevier, vol. 90(2-3), pages 140-148, May.
    • Handle: RePEc:eee:hepoli:v:90:y:2009:i:2-3:p:140-148
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    3. Ugolini, Cristina & Lippi Bruni, Matteo & Leucci, Anna Caterina & Fiorentini, Gianluca & Berti, Elena & Nobilio, Lucia & Moro, Maria Luisa, 2019. "Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes," Health Policy, Elsevier, vol. 123(10), pages 955-962.
    4. Wyeth Pullyblank, Ryan & Laudicella, Mauro & Rose Olsen, Kim, 2020. "Cost and quality impacts of treatment loci for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-basedmonitoring," DaCHE discussion papers 2020:1, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    5. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
    6. Gianluca Fiorentini & Elisa Iezzi & Matteo Lippi Bruni & Cristina Ugolini, 2011. "Incentives in primary care and their impact on potentially avoidable hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 297-309, August.
    7. Pulleyblank, Ryan & Laudicella, Mauro & Olsen, Kim Rose, 2021. "Cost and quality impacts of treatment setting for type 2 diabetes patients with moderate disease severity: Hospital- vs. GP-based monitoring," Health Policy, Elsevier, vol. 125(6), pages 760-767.
    8. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    9. Mascia, Daniele & Dandi, Roberto & Di Vincenzo, Fausto, 2014. "Professional networks and EBM use: A study of inter-physician interaction across levels of care," Health Policy, Elsevier, vol. 118(1), pages 24-36.
    10. Thaksha Thavam & Rose Anne Devlin & Amardeep Thind & Gregory S. Zaric & Sisira Sarma, 2020. "The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1279-1293, December.
    11. Nicolas da Silva, 2012. "Motivation et performance des médecins. Un examen de la littérature empirique," Post-Print hal-01480872, HAL.
    12. Visca, Modesta & Donatini, Andrea & Gini, Rosa & Federico, Bruno & Damiani, Gianfranco & Francesconi, Paolo & Grilli, Leonardo & Rampichini, Carla & Lapini, Gabriele & Zocchetti, Carlo & Di Stanislao,, 2013. "Group versus single handed primary care: A performance evaluation of the care delivered to chronic patients by Italian GPs," Health Policy, Elsevier, vol. 113(1), pages 188-198.
    13. Tor Iversen & Hilde Lurås, 2012. "Capitation and Incentives in Primary Care," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 26, Edward Elgar Publishing.
    14. 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.
    15. L. F. Andrade & T. Rapp & C. Sevilla-Dedieu, 2018. "Quality of diabetes follow-up care and hospital admissions," International Journal of Health Economics and Management, Springer, vol. 18(2), pages 153-167, June.
    16. Diop, Mamadou & Fiset-Laniel, Julie & Provost, Sylvie & Tousignant, Pierre & Borgès Da Silva, Roxane & Ouimet, Marie-Jo & Latimer, Eric & Strumpf, Erin, 2017. "Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec’s Family Medicine Groups, 2002–2010," Health Policy, Elsevier, vol. 121(4), pages 378-388.
    17. 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.

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