Effects of pay-for-performance for primary care physicians on preventable diabetes-related hospitalization costs among adults in New Brunswick: a quasi-experimental evaluation

This study assesses the impacts of the P4P scheme on excess healthcare costs.MethodsWe use a quasi-experimental study design drawing on linked population-based administrative data sets of physician billings, hospital discharge abstracts, and provider and resident registrations. Prospective cohorts of patients with diabetes are identified through a validated algorithm tracing individuals’ interactions with the healthcare system. We apply propensity-score difference-in-differences estimation for effects of P4P on preventable diabetes-related hospitalization costs, by patient exposure to physician uptake of the incentive.ResultsCoverage of incentivized care peaked at less than half (44%) of adults with diabetes, who tended to be younger and less often presenting comorbid conditions compared to those whose provider did not claim incentives. Introduction of P4P was attributed to significantly lower diabetes hospitalization costs among newly diagnosed patients (-0.083,p<0.01) and improved compensation for physicians. No cost avoidance was established among medium and longer term patients nor for hospitalizations for conditions concordant with diabetes.InterpretationEffects of New Brunswick’s P4P for diabetes care are mixed. Results reflect the deficient evidence base on effects of P4P on patient-oriented and policymaker-important health outcomes. High risk of multiple morbidities among patients with diabetes and heterogeneity of physician responses to performance incentives...
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research