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Selection bias in GP fundholding

D L Baines1, D K Whynes

  • 1Department of Economics, University of Nottingham, U.K.

Health Economics
|March 1, 1996
PubMed
Summary
This summary is machine-generated.

General practices in the UK that became fundholders under the National Health Service Act were more likely to meet quality targets. Analysis revealed selection bias in fundholding practices, with a structural break in wave four.

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Area of Science:

  • Health Services Research
  • Health Policy Analysis
  • Econometrics in Healthcare

Background:

  • The 1990 National Health Services Act introduced general practice fundholding in the UK.
  • Fundholding aimed to increase practice autonomy and efficiency in resource management.
  • Understanding the characteristics of early fundholders is crucial for policy evaluation.

Purpose of the Study:

  • To analyze the differences between general practices that became fundholders and those that remained non-fundholders.
  • To assess whether fundholders met government-set quality criteria.
  • To investigate potential selection bias and structural breaks in fundholding characteristics over time.

Main Methods:

  • Logistic regression modeling using 1993 data from Lincolnshire Family Health Services Authority.

Related Experiment Videos

  • Analysis of practice characteristics against quality criteria (prescribing costs, minor surgery, cervical screening).
  • Forecasting of the fourth wave of fundholding to identify structural changes.

    • Main Results:

    • Fundholding practices demonstrated higher adherence to quality criteria compared to non-fundholders.
    • High classification accuracy was achieved in distinguishing between fundholding and non-fundholding practices.
    • Poor prediction for the fourth wave indicated a structural break in fundholder characteristics.
    • Evidence of selection bias was found in the first three waves and persisted in the fourth wave.

    Conclusions:

    • General practice fundholding, particularly in its early waves, was associated with better performance on key quality indicators.
    • A significant structural shift occurred in the characteristics of fundholders by the fourth wave.
    • Selection bias influenced practice participation in fundholding across multiple waves, suggesting non-random self-selection.