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.

非目标患者支付激励对结果的溢出机制研究。
医疗保健支付改革可能会对同一提供者治疗的非目标患者的护理产生溢出效应。很少有实证研究定量地调查了这些效应背后的机制。我们制定了理论驱动的假设来研究英国国家卫生服务区域支付改革的溢出机制,使用关联的患者-医生数据和差异中的差异方法。我们发现,与对照地区相比,由没有接触奖励的医生治疗的非目标急诊患者的区域支付变化与死亡率增加0.321个百分点(S.E. 0.114)相关。相比之下,每季度每增加一名目标患者接受医生治疗,非目标患者的死亡率降低0.008个百分点(S.E. 0.002)。这些发现在一系列敏感性分析中是一致的。研究结果表明,医疗服务提供者从非目标患者身上转移了资源,但患者从医生从激励中学习中受益。我们展示了关于溢出机制的理论驱动假设如何能够提高对溢出效应如何以及在何处发生的理解,从而有助于研究设计和政策制定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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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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