Investigating the Spillover Mechanisms of Payment Incentives on the Outcomes for Non-Targeted Patients.

IF 2 3区 医学 Q2 ECONOMICS
Health economics Pub Date : 2025-03-21 DOI:10.1002/hec.4956
Philip Britteon, Søren Rud Kristensen, Yiu-Shing Lau, Ruth McDonald, Matt Sutton
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引用次数: 0

Abstract

Payment reforms in healthcare can have spillover effects on the care experienced by non-targeted patients treated by the same provider. Few empirical studies have quantitatively investigated the mechanisms behind these effects. We formulate theory-driven hypotheses to investigate the spillover mechanisms of a regional payment reform in the English National Health Service, using linked patient-physician data and difference-in-differences methods. We show that regional payment changes were associated with an increase in mortality of 0.321 percentage points (S.E. 0.114) for non-targeted emergency patients who were treated by physicians with no exposure to the incentives, compared to control regions. In contrast, the mortality rate for non-targeted patients reduced by 0.008 percentage points (S.E. 0.002) for every additional targeted patient treated per quarter by their physician. These findings were consistent across a range of sensitivity analyses. The findings suggest that providers diverted resources away from non-targeted patients but that patients benefitted from physicians learning from the incentives. We demonstrate how the formulation of theory-driven hypotheses about spillover mechanisms can improve the understanding of how and where spillover effects may occur, contributing to research design and policymaking.

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来源期刊
Health economics
Health economics 医学-卫生保健
CiteScore
3.60
自引率
4.80%
发文量
177
审稿时长
4-8 weeks
期刊介绍: This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.
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