Abstract
This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Using provider-level outcome data for 2005–2013 from the Swedish Prescription Register, providers in regions using P4P were compared to providers in other regions in a difference-in-differences analysis. The results indicate that P4P improved guideline compliance regarding prescription of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. The effect was mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers.
Highlights
Pay-for-performance (P4P), incentives tied to performance targets, has been a popular strategy to improve care quality in many countries
The changing angiotensin converting enzyme (ACE) share of private providers reflected a substitution of angiotensin receptor blockers (ARB) for ACE, while for public providers it was more a case of less growth of the ARB prescriptions
The effect on the ACE share became insignificant once the incentive was removed, one reason for the insignificance may be that only 103 observations identify these estimates
Summary
Pay-for-performance (P4P), incentives tied to performance targets, has been a popular strategy to improve care quality in many countries. Public provision is a key feature of many healthcare systems, there is to the best of our knowledge no study of whether private and public providers respond differently to P4P. One may expect the power of monetary incentives to be weaker for public care providers for at least two reasons. Public employees may be more driven by intrinsic motivation for their work than private employees, suggesting that external incentives (such as P4P) may be less effective in public organizations (Frey et al 2013; Georgellis et al 2011). Employed physicians with career concerns may respond to the scheme, as it allows them to signal high ability (Holmström 1999)
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