Do Physicians Respond to Additional Capitation Payments in Mixed Remuneration Schemes?

Area of Science:

• Health Economics
• Primary Care Policy
• Healthcare Management

Background:

• Mixed remuneration schemes combine capitation and fee-for-service (FFS) payments, creating incentives for patient list expansion and service provision.
• Patients with complex needs require longer consultations, posing a risk of unequal access if payment structures do not account for patient characteristics.

Purpose of the Study:

• To assess the impact of a natural experiment introducing additional capitation for general practitioners (GPs) serving complex patient populations or located in specific geographical areas.
• To evaluate the effects of this reform on the number of patients per GP, services per patient, and GP income, particularly concerning equity in access for complex patients.

Main Methods:

• Utilized a difference-in-difference (DiD) model to analyze data from a natural experiment involving two capitation schemes (moderate and intensive).
• Examined changes in patient volume and service provision levels before and after the reform's implementation.
• Assessed the impact on GP income, considering a national budget constraint that made some eligible GPs ineligible for the additional payment.

Main Results:

• Both the moderate and intensive capitation schemes showed tendencies towards reductions in the number of patients served per GP.
• Service provision per patient also decreased, including for complex patients, indicating no improvement in access equity.
• GP income experienced a 2.5% increase in the first year, but this effect became statistically insignificant in the second year.

Conclusions:

• The implemented reform, despite aiming to support GPs with complex patients, did not enhance equity in healthcare access.
• The observed income stabilization suggests GPs may prioritize leisure over increased earnings, aligning with the target income hypothesis.
• Further research is needed to refine remuneration models to ensure equitable access for all patient groups in primary care settings.