Increasing capitation in mixed remuneration schemes: Effects on service provision and process quality of care

Many health systems apply mixed remuneration schemes for general practitioners, but little is known about the effects on service provision of changing the relative mix of fee for services and capitation. We apply difference-in-differences analyses to evaluate a reform that effectively reversed the m...

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Bibliographic Details
Published in:Health economics 2023-11, Vol.32 (11), p.2477-2498
Main Authors: Skovsgaard, Christian Volmar, Kristensen, Troels, Pulleyblank, Ryan, Olsen, Kim Rose
Format: Article
Language:English
Subjects:
Capitation
Compensation
Diabetes
Family physicians
Fees & charges
General practice
Health care
Health care policy
Health economics
Health services
Patients
Quality of care
Services
Type 2 diabetes mellitus
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Summary:Many health systems apply mixed remuneration schemes for general practitioners, but little is known about the effects on service provision of changing the relative mix of fee for services and capitation. We apply difference-in-differences analyses to evaluate a reform that effectively reversed the mix between fee for services and capitation from 80/20 to 20/80 for patients with type 2 diabetes. Our results show reductions in provision of both the contact services that became capitated and in other non-capitated (still-billable) services. Reduced provision also occurred for guideline-recommended process quality services. We find that the effects are mainly driven by patients with co-morbidities and by general practitioners with high income, relatively many diabetes patients, and solo practitioners. Thus, increasing capitation in a mixed remuneration schemes appears to reduce service provision for patients with type 2 diabetes monitored in general practice with a risk of unwanted quality effects.
ISSN:1057-9230
1099-1050
DOI:10.1002/hec.4736