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The European Journal of Health Economics
Published in: The European Journal of Health Economics 6/2016

01-07-2016 | Original Paper

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

Authors: Audrey Michel-Lepage, Bruno Ventelou

Published in: The European Journal of Health Economics | Issue 6/2016

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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.
Footnotes
1
For patients above 65 years old, the prescriptions of benzodiazepines vary between 5.1 and 5.6 % from 2007 to 2012. The precise figure of 5 % has been defined accordingly with a mixture of two purposes: firstly to “interrupt” the increasing trend of benzodiazepines consumption (5.1 % was the effective rate in 2010) and secondly to be achievable. Indeed, the P4P program had to be politically acceptable (P4P contract had been negotiated with Unions and, if target objectives are too difficult to achieve, GPs would have not made efforts to reach them).
 
2
A "naive model" in this context is a model without any endogeneity-bias correction.
 
3
The percentages of the Table 1 are “aggregate” statistics, mixing effects (natural progression and specific CAPI impact).
 
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Metadata
Title
The true impact of the French pay-for-performance program on physicians’ benzodiazepines prescription behavior
Authors
Audrey Michel-Lepage
Bruno Ventelou
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 6/2016
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-015-0717-6

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