Cristina Ugolini

Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care

OBJECTIVES We investigate the impact on quality of care of the introduction of two financial incentives in primary care contracts in the Italian region Emilia Romagna: pay-for-participation and pay-for-compliance with best practices programs. METHODS We concentrate on patients affected by diabetes mellitus type 2, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We test the hypothesis that, other things equal, patients under the responsibility of general practitioners (GPs) receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies. To this end, we examine the combined influence of physician, organisational and patient factors by means of multilevel modelling for the year 2003. RESULTS Programs aimed at stimulating GP assumption of responsibility in disease management significantly reduce the probability of hyperglycaemic emergencies for their patients. CONCLUSIONS Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence healthcare outcomes. Our results support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

Economic Incentives in General Practice: The Impact of Pay for Participation Programs on Diabetes Care

Financial incentives are increasingly adopted to improve allocative efficiency and quality in primary care. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence healthcare outcomes and on the degree of physicians’ responsiveness to their introduction. This problem reflects the lack of adequate empirical data but also the complexity of general practice systems where many confounding and institutional factors are likely to influence physician behaviour. Given this background, we investigate the impact on quality of care of the introduction of payfor- participation incentives in primary care contracts in the Italian region Emilia Romagna. We concentrate on patients affected by diabetes mellitus type 2, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience hospitalisation for hyperglycaemic emergencies. To this end, we examined the combined influence of physician, organisational and patient factors through the use of multilevel modelling. Data were obtained form a large dataset made available by the Regional Agency for Health Care Services of Emilia Romagna. This dataset covers patients and GPs of the whole region and provides detailed information on healthcare consumption of the population, on the different components of GP remunerations, on morbidity levels of large groups of patients. Estimations are obtained for the year 2003.

Assistenza a domicilio e assistenza residenziale: politiche di intervento e analisi empirica

Although in Italy most Long-Term Care is still provided in kind by unpaid informal caregivers, families are less and less likely to be in the condition to care for a disabled elderly. Given the social and financial implications associated with this trend, there is a growing interest in understanding the determinants of family decisions regarding living arrangements of the elderly, in order to implement effective policy measures aimed at containing costs and to enhance the quality of care. We estimate the effects of various household and individual characteristics on the choice of living care arrangement, considering a representative population sample of the Italian region Emilia Romagna. We exploit detailed information on the health conditions of the elderly person, on household socio-economic status and on family attitudes towards current welfare state services in order to identify the main determinants of the choice between institutionalisation and home care. Our results outline the predominance of disability indicators as opposed to family characteristics, economic variables and public services availability in determining the decision of the family. In an context in which social norms about filial responsibility still tend to consider the elderly institutionalisation with a consistent amount of social stigma, the institutionalisation is strictly influenced by the growing functional or cognitive impairments of the elderly and, to a lower extent, by economic status. Partly different from the international empirical literature, wealthier households have a larger probability to opt for the residential alternative

Dealing with Minor Illnesses: The Link between Primary Care Characteristics and First Aid Clinics’ Attendances

The reformulation of existing boundaries between primary and secondary care, in order to shift selected services traditionally provided by Emergency Departments to community-based alternatives has determined a variety of organisational solutions aimed at reducing the ED overcrowding. One innovative change has been the introduction of fast-track systems for minor injuries or illnesses, whereby community care providers are involved in order to divert patients away from EDs. These facilities offer an open-access service for patients not requiring hospital treatments, and may be staffed by nurses and/or primary care general practitioners operating within, or alongside, the ED. To date little research has been undertaken on such experiences. To fill this gap, we analyse a First-aid clinic (FaC) in the Italian city of Parma, consisting of a minor injury unit located alongside the teaching hospital’s ED. We examine the link between the utilisation rates of the FaC and primary care characteristics, focusing on the main organisational features of the practices and estimating panel count data models for 2007-2010. Our main findings indicate that the younger cohorts are heavy users of the FaC and that the extension of practice opening hours significantly lowers the number of attendances, after controlling for GP’s and practice’s characteristics.