Primary Care Characteristics and Their Impact on Potentially Avoidable Hospital Admissions
Posted: 22 Jun 2007
Given the increasing emphasis on the appropriateness of care, GPs are more and more involved in demand control strategies and we observe a growing interest in understanding GPs prescribing behaviour and in identifying the determinants of their allocative choices. Within this framework, the financial incentives (especially pay-for-performance programs) are increasingly adopted to promote higher quality of care. Besides, different alternative solutions have also been explored such as payments for participation in improvement activities and for compliance with guidelines. Few studies have examined the relationship between the nature of GPs contractual arrangements and the quality of primary care, and there is no evidence in Italy on the extent to which financial incentives on GPs can reduce avoidable hospital admissions.
The paper examines whether the nature of primary care organisation and of contractual arrangements with NHS affect a set of medical conditions named Ambulatory Care Sensitive conditions (ACSCs). Admissions for ACSCs are potentially avoidable hospital admissions where timely and effective intervention outside the hospital can reduce the risk of hospitalisation by either preventing the onset of an illness or condition, controlling an acute episodic illness, or managing a chronic disease.
We investigate the impact of economic incentives in Regional and Local Health Authority contracts for primary care in the Italian region Emilia-Romagna over the period 2000-05, distinguishing pay-for-performance schemes from pay-for- participation and pay-for-compliance programs. We base our study on a dataset that links epidemiological and administrative databases and covers patients and GPs of the whole region. Since data on patients characteristics are nested within general practices and in turn GP characteristics are nested within LHAs, we use multilevel analysis (MLe) to assess the influence of the different components of GP remuneration on the rate of preventable hospitalisations (ACSCs) after controlling for in the main risk factors.
Keywords: Primary care, financial incentives, preventable hospitalisation, multilevel modelling.
JEL Classification: I11, I18, C30
Suggested Citation: Suggested Citation