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Family doctor responses to changes in target stringency under financial incentives

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  • Wilding, Anna
  • Munford, Luke
  • Guthrie, Bruce
  • Kontopantelis, Evangelos
  • Sutton, Matt

Abstract

Healthcare providers may game when faced with targets. We examine how family doctors responded to a temporary but substantial increase in the stringency of targets determining payments for controlling blood pressure amongst younger hypertensive patients. We apply difference-in-differences and bunching techniques to data from electronic health records of 107,148 individuals. Doctors did not alter the volume or composition of lists of their hypertension patients. They did increase treatment intensity, including a 1.2 percentage point increase in prescribing antihypertensive medicines. They also undertook more blood pressure measurements. Multiple testing increased by 1.9 percentage points overall and by 8.8 percentage points when first readings failed more stringent target. Exemption of patients from reported performance increased by 0.8 percentage points. Moreover, the proportion of patients recorded as exactly achieving the more stringent target increased by 3.1 percentage points to 16.6%. Family doctors responded as intended and gamed when set more stringent pay-for-performance targets.

Suggested Citation

  • Wilding, Anna & Munford, Luke & Guthrie, Bruce & Kontopantelis, Evangelos & Sutton, Matt, 2022. "Family doctor responses to changes in target stringency under financial incentives," Journal of Health Economics, Elsevier, vol. 85(C).
    • Handle: RePEc:eee:jhecon:v:85:y:2022:i:c:s0167629622000704
    DOI: 10.1016/j.jhealeco.2022.102651
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    References listed on IDEAS

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    1. Hugh Gravelle & Matt Sutton & Ada Ma, 2010. "Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?," Economic Journal, Royal Economic Society, vol. 120(542), pages 129-156, February.
    2. Emmanuel Saez, 2010. "Do Taxpayers Bunch at Kink Points?," American Economic Journal: Economic Policy, American Economic Association, vol. 2(3), pages 180-212, August.
    3. Jonathan Gruber & Thomas P. Hoe & George Stoye, 2023. "Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers," The Review of Economics and Statistics, MIT Press, vol. 105(1), pages 1-19, January.
    4. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    5. Peter Smith, 1990. "The Use of Performance Indicators in the Public Sector," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 153(1), pages 53-72, January.
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    Cited by:

    1. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Kokot, Johanna & Wiesen, Daniel, 2024. "A new look at physicians’ responses to financial incentives: Quality of care, practice characteristics, and motivations," Journal of Health Economics, Elsevier, vol. 94(C).
    2. Jamie O’Halloran & Anne Sophie Oxholm & Line Bjørnskov Pedersen & Dorte Gyrd‐Hansen, 2024. "Going the extra mile? General practitioners' upcoding of fees for home visits," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 197-203, February.

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    More about this item

    Keywords

    Financial incentives; Provider behaviour; Gaming; Pay for performance; Targets;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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