Family doctor responses to changes in target stringency under financial incentives

Anna Wilding; Luke Munford; Bruce Guthrie; Evangelos Kontopantelis; Matt Sutton

doi:10.1016/j.jhealeco.2022.102651

Family doctor responses to changes in target stringency under financial incentives

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

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	102651
Journal	Journal of Health Economics
Volume	85
Early online date	2 Jul 2022
DOIs	https://doi.org/10.1016/j.jhealeco.2022.102651
Publication status	Published - 2 Jul 2022

Keywords

Financial incentives
Gaming
Pay for performance
Provider behaviour
Targets

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10.1016/j.jhealeco.2022.102651Licence: CC BY

Health and Wellbeing in Later Life Management, Predictions and Interventions.
Munford, L. (PI), Banks, J. (CoI) & Sutton, M. (CoI)
1/09/16 → 31/08/19
Project: Research

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title = "Family doctor responses to changes in target stringency under financial incentives",

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.",

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note = "Funding Information: This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme as part of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). AW was funded by a Wellcome Doctoral Studentship, ref. 217868/Z/19/Z. LAM was supported by the Medical Research Council, through a Skills Development Fellowship (grant number MR/N015126/1). LAM, MS and EK receive funding from the NIHR Applied Research Collaboration Greater Manchester (NIHR200174). MS is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily the NIHR, the NHS or the Department for Health and Social Care. Funding Information: This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme as part of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). AW was funded by a Wellcome Doctoral Studentship, ref. 217868/Z/19/Z. LAM was supported by the Medical Research Council, through a Skills Development Fellowship (grant number MR/N015126/1). LAM, MS and EK receive funding from the NIHR Applied Research Collaboration Greater Manchester (NIHR200174). MS is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily the NIHR, the NHS or the Department for Health and Social Care. We are grateful to participants at the 2019 Australasian Workshop on Econometrics and Health Economics for helpful comments. Publisher Copyright: {\textcopyright} 2022",

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N1 - Funding Information: This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme as part of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). AW was funded by a Wellcome Doctoral Studentship, ref. 217868/Z/19/Z. LAM was supported by the Medical Research Council, through a Skills Development Fellowship (grant number MR/N015126/1). LAM, MS and EK receive funding from the NIHR Applied Research Collaboration Greater Manchester (NIHR200174). MS is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily the NIHR, the NHS or the Department for Health and Social Care. Funding Information: This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme as part of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). AW was funded by a Wellcome Doctoral Studentship, ref. 217868/Z/19/Z. LAM was supported by the Medical Research Council, through a Skills Development Fellowship (grant number MR/N015126/1). LAM, MS and EK receive funding from the NIHR Applied Research Collaboration Greater Manchester (NIHR200174). MS is an NIHR Senior Investigator. The views expressed are those of the authors and not necessarily the NIHR, the NHS or the Department for Health and Social Care. We are grateful to participants at the 2019 Australasian Workshop on Econometrics and Health Economics for helpful comments. Publisher Copyright: © 2022

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Family doctor responses to changes in target stringency under financial incentives

Abstract

Keywords

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Health and Wellbeing in Later Life Management, Predictions and Interventions.

Cite this