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The Introduction of Pay-for-Performance: What Impact on General Practitioners' Activity in France?

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  • Brigitte Dormont
  • Aimée Kingsada
  • Anne-Laure Samson

Abstract

[eng] In 2009, a system of pay-for-performance (P4P) was offered to physicians in France via the Contrat d’Amélioration des Pratiques Individuelles (CAPI). This study assesses the causal impact of CAPI on their behaviour in terms of care provision. Based on a panel of general practitioners in private practice observed before (2005 and 2008) and after (2011) its introduction, we use an instrumental variables approach, applied to a model in first-differences in order to correct the endogeneity biases linked to the fact that signing up to CAPI is a choice. We show that, unlike other practitioners, those who have signed up to CAPI have not reduced their number of consultations per patient or the amount of prescriptions per patient. They have also increased, to a greater extent than others, the proportion of their patients who they treat as the primary care doctor(i.e. the médecin traitant). Moreover, CAPI has enabled them to increase their fees per patient with, as a consequence, a higher treatment cost for the Social Security system.

Suggested Citation

  • Brigitte Dormont & Aimée Kingsada & Anne-Laure Samson, 2021. "The Introduction of Pay-for-Performance: What Impact on General Practitioners' Activity in France?," Economie et Statistique / Economics and Statistics, Institut National de la Statistique et des Etudes Economiques (INSEE), issue 524-525, pages 11-29.
    • Handle: RePEc:nse:ecosta:ecostat_2021_524d_2
    DOI: https://doi.org/10.24187/ecostat.2021.524d.2045
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    References listed on IDEAS

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    1. Kleibergen, Frank & Paap, Richard, 2006. "Generalized reduced rank tests using the singular value decomposition," Journal of Econometrics, Elsevier, vol. 133(1), pages 97-126, July.
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    3. Jasmin Kantarevic & Boris Kralj, 2013. "Link Between Pay For Performance Incentives And Physician Payment Mechanisms: Evidence From The Diabetes Management Incentive In Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1417-1439, December.
    4. B. Dormont & A.‐L. Samson, 2008. "Medical demography and intergenerational inequalities in general practitioners' earnings," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1037-1055, September.
    5. Carine Franc & Romain Lesur, 2004. "Systèmes de rémunération des médecins et incitations à la prévention," Revue économique, Presses de Sciences-Po, vol. 55(5), pages 901-922.
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    7. 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.
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    1. Lin, Tracy Kuo & Werner, Kalin & Witter, Sophie & Alluhidan, Mohammed & Alghaith, Taghred & Hamza, Mariam M. & Herbst, Christopher H. & Alazemi, Nahar, 2022. "Individual performance-based incentives for health care workers in Organisation for Economic Co-operation and Development member countries: a systematic literature review," Health Policy, Elsevier, vol. 126(6), pages 512-521.

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    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • C26 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Instrumental Variables (IV) Estimation

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