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International Journal of Health Economics and Management

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01-06-2017 | Research Article

Effect of pay-for-performance on cervical cancer screening participation in France

Authors: Panayotis Constantinou, Jonathan Sicsic, Carine Franc

Published in: International Journal of Health Economics and Management | Issue 2/2017

Abstract

Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006–2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.

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Women under a specific scheme (Affection Longue Durée, ALD) administered by the national health insurance, that waives copayments related to the treatment of specific chronic conditions.

The use of a fixed-effects estimator was not possible due to the existence of time-invariant information such as area of residence. Indeed, 96% of included women did not change area of residence during our study period. These analyses were conducted as robustness analyses and the discussion about the choice between fixed or random effects for longitudinal analysis falls out of the scope of our work.

Data collection methods can also be more or less within provider’s control: we note in Table 1S that some chronic disease management indicators concern outcome measures and that achievement rate is based upon physician self-report. Achievement increased for these indicators even though outcome measures are supposedly harder to achieve than process measures.

We thank the French national health insurance (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, CNAMTS) for giving us access to unpublished achievement data.

Andrae, B., Andersson, T. M.-L., Lambert, P. C., Kemetli, L., Silfverdal, L., Strander, B., et al. (2012). Screening and cervical cancer cure: Population based cohort study. BMJ (Clinical research ed.), 344, e900.CrossRef

Anttila, A., von Karsa, L., Aasmaa, A., Fender, M., Patnick, J., Rebolj, M., et al. (2009). Cervical cancer screening policies and coverage in Europe. European Journal of Cancer, 45(15), 2649–2658. doi:10.1016/j.ejca.2009.07.020.CrossRefPubMed

Arbyn, M., Raifu, A. O., Weiderpass, E., Bray, F., & Anttila, A. (2009). Trends of cervical cancer mortality in the member states of the European Union. European Journal of Cancer (Oxford, England: 1990), 45(15), 2640–2648. doi:10.1016/j.ejca.2009.07.018.CrossRef

Assurance Maladie. (2016). La ROSP, une amélioration continue en faveur de la qualité et de la pertinence des soins, bilan à 4 ans. http://www.ameli.fr/fileadmin/user_upload/documents/DP_Bilan_ROSP_2015-210416.pdf.

Carrieri, V., & Bilger, M. (2013). Preventive care: Underused even when free. Is there something else at work? Applied Economics, 45(2), 239–253.CrossRef

Commission des Comptes de la Sécurité Sociale. (2013). fiche éclairage ROSP. http://www.securite-sociale.fr/IMG/pdf/fiche_eclairage_objectifs_sante_publique.pdf.

Constantinou, P., Dray-Spira, R., & Menvielle, G. (2016). Cervical and breast cancer screening participation for women with chronic conditions in France: Results from a national health survey. BMC Cancer, 16(1), 255. doi:10.1186/s12885-016-2295-0.CrossRefPubMedPubMedCentral

Duport, N., Serra, D., Goulard, H., & Bloch, J. (2008). Which factors influence screening practices for female cancer in France? Revue D’épidémiologie Et De Santé Publique, 56(5), 303–313. doi:10.1016/j.respe.2008.07.086.CrossRefPubMed

Duport, N., Salines, E., & Grémy, I. (2014). Premiers résultats de l’évaluation du programme expérimental de dépistage organisé du cancer du col de l’utérus, France, 2010–2012. Bull Epidémiol Hebd, 2014(13–14–15), 228–234. my in reference Duport et al. (2014).

Eijkenaar, F. (2013). Key issues in the design of pay for performance programs. The European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care, 14(1), 117–131. doi:10.1007/s10198-011-0347-6.CrossRefPubMed

Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013). Effects of pay for performance in health care: A systematic review of systematic reviews. Health Policy (Amsterdam, Netherlands), 110(2–3), 115–130. doi:10.1016/j.healthpol.2013.01.008.CrossRef

Emmert, M., Eijkenaar, F., Kemter, H., Esslinger, A. S., & Schoffski, O. (2012). Economic evaluation of pay-for-performance in health care: A systematic review. European Journal of Health Economics, 13(6), 755–767. doi:10.1007/s10198-011-0329-8.CrossRefPubMed

Franc, C., & Lesur, R. (2004). Systèmes de rémunération des médecins et incitations à la prévention. Revue économique, 55(5), 901–922.

French, B., & Heagerty, P. J. (2008). Analysis of longitudinal data to evaluate a policy change. Statistics in Medicine, 27(24), 5005–5025. doi:10.1002/sim.3340.CrossRefPubMedPubMedCentral

Habbema, D., de Kok, I. M., & Brown, M. L. (2012). Cervical cancer screening in the United States and the Netherlands: A tale of two countries. The Milbank Quarterly, 90(1), 5–37. doi:10.1111/j.1468-0009.2011.00652.x.CrossRefPubMedPubMedCentral

Hakama, M., Chamberlain, J., Day, N. E., Miller, A. B., & Prorok, P. C. (1985). Evaluation of screening programmes for gynaecological cancer. British Journal of Cancer, 52(4), 669–673.CrossRefPubMedPubMedCentral

HAS. (2010). État des lieux et recommandations pour le dépistage du cancer du col de l’utérus en France.

Hennig-Schmidt, H., Selten, R., & Wiesen, D. (2011). How payment systems affect physicians’ provision behaviour-an experimental investigation. Journal of Health Economics, 30(4), 637–646. doi:10.1016/j.jhealeco.2011.05.001.CrossRefPubMed

Hickson, G. B., Altemeier, W. A., & Perrin, J. M. (1987). Physician reimbursement by salary or fee-for-service: Effect on physician practice behavior in a randomized prospective study. Pediatrics, 80(3), 344–350.PubMed

Hillman, A. L., Ripley, K., Goldfarb, N., Nuamah, I., Weiner, J., & Lusk, E. (1998). Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care. American Journal of Public Health, 88(11), 1699–1701.CrossRefPubMedPubMedCentral

Hu, F. B., Goldberg, J., Hedeker, D., Flay, B. R., & Pentz, M. A. (1998). Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. American Journal of Epidemiology, 147(7), 694–703.CrossRefPubMed

Jepson, R., Clegg, A., Forbes, C., Lewis, R., Sowden, A., & Kleijnen, J. (2000). The determinants of screening uptake and interventions for increasing uptake: A systematic review. Health Technology Assessment (Winchester, England), 4(14), i–vii, 1–133.

Kaczorowski, J., Hearps, S. J. C., Lohfeld, L., Goeree, R., Donald, F., Burgess, K., et al. (2013). Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates. Canadian Family Physician Médecin De Famille Canadien, 59(6), e282–289.PubMedPubMedCentral

Kenkel, D. S. (1994). The demand for preventive medical care. Applied Economics, 26(4), 313.CrossRef

Kiran, T., Wilton, A. S., Moineddin, R., Paszat, L., & Glazier, R. H. (2014). Effect of payment incentives on cancer screening in Ontario primary care. Annals of Family Medicine, 12(4), 317–323. doi:10.1370/afm.1664.CrossRefPubMedPubMedCentral

Krasnik, A., Groenewegen, P. P., Pedersen, P. A., von Scholten, P., Mooney, G., Gottschau, A., et al. (1990). Changing remuneration systems: Effects on activity in general practice. BMJ (Clinical Research Ed.), 300(6741), 1698–1701.CrossRef

Larsen, L. P., & Olesen, F. (1996). Characteristics of subgroups of attenders and non-attenders in an organised screening programme for cervical cancer. Journal of Medical Screening, 3(3), 133–139.CrossRefPubMed

Levi, F., Lucchini, F., Negri, E., Franceschi, S., & la Vecchia, C. (2000). Cervical cancer mortality in young women in Europe: Patterns and trends. European Journal of Cancer (Oxford, England: 1990), 36(17), 2266–2271.CrossRef

Leyden, W. A., Manos, M. M., Geiger, A. M., Weinmann, S., Mouchawar, J., Bischoff, K., et al. (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. Journal of the National Cancer Institute, 97(9), 675–683. doi:10.1093/jnci/dji115.CrossRefPubMed

Li, J., Hurley, J., Decicca, P., & Buckley, G. (2014). Physician response to pay-for-performance: Evidence from a natural experiment. Health Economics, 23(8), 962–978. doi:10.1002/(ISSN)1099-1050/issues.CrossRefPubMed

Liang, K.-Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 13–22. doi:10.1093/biomet/73.1.13.CrossRef

Lim, A. W. W., & Sasieni, P. (2015). Consultation rates in cervical screening non-attenders: opportunities to increase screening uptake in GP primary care. Journal of Medical Screening, 22(2), 93–99. doi:10.1177/0969141315573345.CrossRefPubMedPubMedCentral

Maxwell, C. J., Bancej, C. M., Snider, J., & Vik, S. A. (2001). Factors important in promoting cervical cancer screening among Canadian women: Findings from the 1996–97 National Population Health Survey (NPHS). Canadian Journal of Public Health, 92(2), 127–133.PubMed

Maynard, A. (2012). The powers and pitfalls of payment for performance. Health Economics, 21(1), 3–12. doi:10.1002/(ISSN)1099-1050/issues.CrossRefPubMed

Meeker, D., Joyce, G. F., Malkin, J., Teutsch, S. M., Haddix, A. C., & Goldman, D. P. (2011). Coverage and preventive screening. Health Services Research, 46(1 Pt 1), 173–184. doi:10.1111/j.1475-6773.2010.01188.x.CrossRefPubMedPubMedCentral

Miller, A. B. (2002). The (in)efficiency of cervical screening in Europe. European Journal of Cancer (Oxford, England: 1990), 38(3), 321–326.CrossRef

Mullen, K. J., Frank, R. G., & Rosenthal, M. B. (2010). Can you get what you pay for? Pay-for-performance and the quality of healthcare providers. The Rand Journal of Economics, 41(1), 64–91.CrossRefPubMed

O’Connor, M., Murphy, J., Martin, C., O’Leary, J., Sharp, L., & Irish Cervical Screening Consortium (CERVIVA). (2014). Motivators for women to attend cervical screening: The influential role of GPs. Family Practice, 31(4), 475–482. doi:10.1093/fampra/cmu029.

Or, Z., Jusot, F., & Yilmaz, E. (2009). Inégalités de recours aux soins en Europe. Revue économique, 60(2), 521–543.CrossRef

Palència, L., Espelt, A., Rodríguez-Sanz, M., Puigpinós, R., Pons-Vigués, M., Pasarín, M. I., et al. (2010). Socio-economic inequalities in breast and cervical cancer screening practices in Europe: Influence of the type of screening program. International Journal of Epidemiology, 39(3), 757–765. doi:10.1093/ije/dyq003.CrossRefPubMed

Peto, J., Gilham, C., Fletcher, O., & Matthews, F. E. (2004). The cervical cancer epidemic that screening has prevented in the UK. The Lancet, 364(9430), 249–256. doi:10.1016/S0140-6736(04)16674-9.CrossRef

Robinson, J. C. (2001). Theory and practice in the design of physician payment incentives. The Milbank Quarterly, 79(2), 149–177, III.

Rosenthal, M. B., Frank, R. G., Li, Z., & Epstein, A. M. (2005). Early experience with pay-for-performance: From concept to practice. JAMA, 294(14), 1788–1793. doi:10.1001/jama.294.14.1788.CrossRefPubMed

Rousseau, A., Bohet, P., Merlière, J., Treppoz, H., Heules-Bernin, B., & Ancelle-Park, R. Evaluation du dépistage organisé et du dépistage individuel du cancer du col de l’utérus?: utilité des données de l’Assurance maladie. BEH.

Schiffman, M., Castle, P. E., Jeronimo, J., Rodriguez, A. C., & Wacholder, S. (2007). Human papillomavirus and cervical cancer. Lancet (London, England), 370(9590), 890–907. doi:10.1016/S0140-6736(07)61416-0.CrossRef

Scott, A. (2000). Chapter 22 economics of general practice. In B.-H. of H. Economics (Ed.), (Vol. 1, Part B, pp. 1175–1200). Elsevier. http://www.sciencedirect.com/science/article/pii/S1574006400800359. Accessed 16 Sept 2015.

Sicsic, J., & Franc, C. (2014). Obstacles to the uptake of breast, cervical, and colorectal cancer screenings: What remains to be achieved by French national programmes? BMC Health Services Research, 14, 465. doi:10.1186/1472-6963-14-465.CrossRefPubMedPubMedCentral

Sicsic, J., & Franc, C. (2016). Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. The European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care,. doi:10.1007/s10198-016-0813-2.PubMed

Stone, E. G., Morton, S. C., Hulscher, M. E., Maglione, M. A., Roth, E. A., Grimshaw, J. M., et al. (2002). Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Annals of Internal Medicine, 136(9), 641–651.CrossRefPubMed

Town, R., Kane, R., Johnson, P., & Butler, M. (2005). Economic incentives and physicians’ delivery of preventive care: A systematic review. American Journal of Preventive Medicine, 28(2), 234–240. doi:10.1016/j.amepre.2004.10.013.CrossRefPubMed

Tuppin, P., de Roquefeuil, L., Weill, A., Ricordeau, P., & Merlière, Y. (2010). French national health insurance information system and the permanent beneficiaries sample. Revue D’épidémiologie Et De Santé Publique, 58(4), 286–290. doi:10.1016/j.respe.2010.04.005.CrossRefPubMed

Van Herck, P., De Smedt, D., Annemans, L., Remmen, R., Rosenthal, M. B., & Sermeus, W. (2010). Systematic review: Effects, design choices, and context of pay-for-performance in health care. BMC Health Services Research, 10, 247. doi:10.1186/1472-6963-10-247.CrossRefPubMedPubMedCentral

Title: Effect of pay-for-performance on cervical cancer screening participation in France
Authors: Panayotis Constantinou
Jonathan Sicsic
Carine Franc
Publication date: 01-06-2017
Publisher: Springer US
Published in: International Journal of Health Economics and Management / Issue 2/2017
Print ISSN: 2199-9023
Electronic ISSN: 2199-9031
DOI: https://doi.org/10.1007/s10754-016-9207-3

At a glance: The STEP trials

Springer Medicine

Effect of pay-for-performance on cervical cancer screening participation in France

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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