Open AccessPosted Content
Physician Response to Pay-for-Performance: Evidence from a Natural Experiment
Reads0
Chats0
TLDR
The results indicate that responses were modest and that physicians responded to the financial incentives for some services but not others, and provide a cautionary message regarding the effectiveness of employing P4P to increase the quality of health care.Abstract:
Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.read more
Citations
More filters
Journal ArticleDOI
Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association
Adam Cheng,Vinay M. Nadkarni,Mary Beth Mancini,Elizabeth A. Hunt,Elizabeth Sinz,Raina M. Merchant,Aaron Donoghue,Jonathan P. Duff,Walter J. Eppich,Marc Auerbach,Blair L. Bigham,Audrey L Blewer,Paul S. Chan,Farhan Bhanji +13 more
TL;DR: A review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation are provided.
Journal Article
The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care
Aaron Mendelson,Karli Kondo,Cheryl L. Damberg,Allison Low,Makalapua Motu'apuaka,Michele Freeman,Maya E O'Neil,Rose Relevo,Devan Kansagara +8 more
TL;DR: The effectiveness of pay-for-performance programs, which provide financial rewards or penalties to providers or institutions according to performance on measures of quality, is unclear as discussed by the authors, and the effectiveness of PAY-FOR-PERFORMANCE programs is unclear.
Journal ArticleDOI
Pay for Performance in Health Care: An International Overview of Initiatives
TL;DR: Although the programs share many similarities, they differ in several important respects, also when compared with the typical P4P program in the United States, there are clearly possibilities to increase incentive strength and minimize incentives for undesired behavior.
Journal ArticleDOI
Pharmaceutical policies: effects of financial incentives for prescribers
TL;DR: The effects of pharmaceutical policies using financial incentives to influence prescribers' practices on drug use, healthcare utilisation, health outcomes and costs are determined and pay for performance policies are evaluated.
Journal ArticleDOI
Adjusting for unmeasured confounding in nonrandomized longitudinal studies: a methodological review
Adam Streeter,Nan Xuan Lin,Louise Crathorne,Marcela Haasova,Chris Hyde,David Melzer,William Henley +6 more
TL;DR: Well-established econometric methods such as DiD and IVA are commonly used to address unmeasured confounding in nonrandomized longitudinal studies, but researchers often fail to take full advantage of available longitudinal information.
References
More filters
Journal ArticleDOI
How Much Should We Trust Differences-In-Differences Estimates?
TL;DR: In this article, the authors randomly generate placebo laws in state-level data on female wages from the Current Population Survey and use OLS to compute the DD estimate of its "effect" as well as the standard error of this estimate.
Journal ArticleDOI
Matching As An Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme
TL;DR: This paper decompose the conventional measure of evaluation bias into several components and find that bias due to selection on unobservables, commonly called selection bias in econometrics, is empirically less important than other components, although it is still a sizeable fraction of the estimated programme impact.
Journal ArticleDOI
The Provision of Incentives in Firms
TL;DR: In this article, a review of existing work on the provision of incentives for workers is presented, and the authors evaluate this literature in the light of a growing empirical literature on compensation from two perspectives: first, an underlying assumption of this literature is that individuals respond to contracts that reward performance.
Journal ArticleDOI
An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Units
TL;DR: The authors illustrates the danger of spurious regression from this kind of misspecification, using as an example a wage regression estimated on data for individual workers that includes in the specification aggregate regressors for characteristics of geographical states.
Posted Content
Natural and Quasi- Experiments in Economics
Bruce D. Meyer,Bruce D. Meyer +1 more
TL;DR: The advantages of using research designs patterned after randomized experiments and how they can be improved are described and aids in judging the validity of inferences they draw are provided.
Related Papers (5)
Pay for performance: is it the best way to improve control of hypertension?
Tim Doran,Catherine Fullwood +1 more