The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment
The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment
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DOI：
10.1016/j.jhealeco.2005.08.001
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发表时间：
2006-05-01
影响因子：
3.5
通讯作者：
Smith, Peter
中科院分区：
文献类型：
--
作者：
Dusheiko, Mark;Gravelle, Hugh;Smith, Peter
在许多卫生保健系统中，全科医生充当二级保健的看门人。根据1991/1992年至1998/1999年的英国资金持有计划，全科医生可以选择获得预算，以支付某些类型的选择性手术（收费的选择性手术）的费用，并可以保留任何盈余。他们不支付不收费的选修课或急诊费用。非资金持有做法不承担任何类型的住院费用。基金控股将于2005年4月重新引入。我们使用差异中的差异方法对取消资金持有前后的英国全科实践进行了为期4年的大型面板评估。取消基金持有令前基金持有人的收费选修入学率增加3.5%至5.1%。对早期基金持有人的影响比后期基金持有人更大（约8%）。我们还对两种不包括在资金持有范围内的招生（免费选修课、紧急情况）使用差异中的差异作为未观察到的时间因素的额外控制。这些差异估计的差异表明，取消资金持有使前资金持有人的收费选修入学增加了4.9%（使用非收费DID）和3.5%（使用紧急DID）。(c) 2005 Elsevier B.V.版权所有
In many health care systems generalist physicians act as gatekeepers to secondary care. Under the English fundholding scheme from 1991/1992 to 1998/1999 general practices could elect to be given a budget to meet the costs of certain types of elective surgery (chargeable electives) for their patients and could retain any surplus. They did not pay for non-chargeable electives or for emergency admissions. Non-fundholding practices did not bear the cost of any type of hospital admissions. Fundholding is to be reintroduced from April 2005.We estimate the effect of fundholding using a differences in differences methodology on a large 4-year panel of English general practices before and after the abolition of fundholding. The abolition of fundholding increased ex-fundholders' admission rates for chargeable elective admissions by between 3.5 and 5.1%. The effect on the early wave fundholders was greater (around 8%) than on later wave fundholders. We also use differences in differences for two types of admissions (non-chargeable electives, emergencies) not covered by fundholding as additional controls for unobserved temporal factors. These differences in differences in differences estimates suggest that the abolition of fundholding increased ex-fundholders' chargeable elective admissions by 4.9% (using the non-chargeables DID) and by 3.5% (using the emergencies DID). (c) 2005 Elsevier B.V. All rights reserved.