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

Christian Volmar Skovsgaard*, Troels Kristensen, Ryan Pulleyblank, Kim Rose Olsen

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Abstract

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.

OriginalsprogEngelsk
TidsskriftHealth Economics
Vol/bind32
Udgave nummer11
Sider (fra-til)2477-2498
ISSN1057-9230
DOI
StatusUdgivet - nov. 2023

Bibliografisk note

Funding Information:
This work was supported by The Novo Nordisk Foundation (Grant number: NNF18OC0033978); and the Norwegian Research Council (Grant number: 288592). European Union's EU Framework Programme for Research and Innovation Horizon 2020 under Grant Agreement 721402.

Publisher Copyright:
© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.

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