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The true impact of the French pay-for-performance program on physicians’ benzodiazepines prescription behavior

Author

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  • Audrey Michel-Lepage

    (Aix Marseille Université (Aix Marseille School of Economics, SESSTIM UMR912)
    IHU, Fondation Méditerranée Infection)

  • Bruno Ventelou

    (Aix Marseille Université (Aix Marseille School of Economics, GREQAM UMR7316)
    ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur)

Abstract

Objectives The French pay-for-performance (P4P) contract CAPI implemented by the national health insurance included a target-goal which aims at reducing benzodiazepines prescriptions. In this investigation, we would like to assess whether: (1) the general practitioners (GPs) having signed P4P contract obtain better results regarding the target-goal than non-signatories; (2) (part of) this progression is due to the CAPI contract itself (tentative measurement of a “causal effect”); (3) (part of) the money spent on this P4P incentive can be self-financed with the amount of pharmaceuticals saved. Methods We matched cross-sectional and longitudinal data including 4622 French GPs from June 2011 to December 2012. A treatment effect model using instrumental variables was performed to take into account potential self-selection issue in signing. After having identified the NET impact of the P4P, we calculate the cost of an avoided benzodiazepines treatment. Results In our study, GPs who have signed the CAPI contract (36 % of the sample) are more numerous in achieving benzodiazepines target goal than non-signatories: 90.7 vs. 85.5 %. After controlling for the self-selection bias, the propensity of GPs to achieve the benzodiazepines target is only 0.31 % higher for signatories than for their non-signing counterparts—estimate for June 2012, which yields a statistically significant gap. Our economic analysis demonstrates that the CAPI contract does not allow savings, but presents in 2012 a NET cost of 93.6€ per avoided benzodiazepines treatment (291€ in 2011). Conclusions The P4P contract has a positive but modest impact on the achievement of GPs regarding benzodiazepines indicator.

Suggested Citation

  • Audrey Michel-Lepage & Bruno Ventelou, 2016. "The true impact of the French pay-for-performance program on physicians’ benzodiazepines prescription behavior," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(6), pages 723-732, July.
    • Handle: RePEc:spr:eujhec:v:17:y:2016:i:6:d:10.1007_s10198-015-0717-6
    DOI: 10.1007/s10198-015-0717-6
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    1. Joshua D. Angrist & Alan B. Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," Journal of Economic Perspectives, American Economic Association, vol. 15(4), pages 69-85, Fall.
    2. repec:fth:prinin:455 is not listed on IDEAS
    3. Saint-Lary, Olivier & Sicsic, Jonathan, 2015. "Impact of a pay for performance programme on French GPs’ consultation length," Health Policy, Elsevier, vol. 119(4), pages 417-426.
    4. 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.
    5. James Heckman & Hidehiko Ichimura & Jeffrey Smith & Petra Todd, 1998. "Characterizing Selection Bias Using Experimental Data," Econometrica, Econometric Society, vol. 66(5), pages 1017-1098, September.
    6. Joshua Angrist & Alan Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," Working Papers 834, Princeton University, Department of Economics, Industrial Relations Section..
    7. James Heckman, 1997. "Instrumental Variables: A Study of Implicit Behavioral Assumptions Used in Making Program Evaluations," Journal of Human Resources, University of Wisconsin Press, vol. 32(3), pages 441-462.
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    Cited by:

    1. Julien Silhol & Bruno Ventelou & Anna Zaytseva, 2020. "How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1391-1398, December.
    2. Sophie Massin & Antoine Nebout & Bruno Ventelou, 2018. "Predicting medical practices using various risk attitude measures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 843-860, July.
    3. Emmanuel Kemel & Antoine Nebout & Bruno Ventelou, 2021. "To test or not to test? Risk attitudes and prescribing by French GPs," Working Papers hal-03330153, HAL.
    4. 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

    Keywords

    Pay-for-performance; CAPI; Benzodiazepines; General practitioners; Behaviors;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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