caa a22 4500 445332395 CHVBK 20180317142741.0 cr unu---uuuuu 170323e20110801xx s 000 0 eng 10.1007/s10198-010-0230-x doi (NATIONALLICENCE)springer-10.1007/s10198-010-0230-x Incentives in primary care and their impact on potentially avoidable hospital admissions [Elektronische Daten] [Gianluca Fiorentini, Elisa Iezzi, Matteo Lippi Bruni, Cristina Ugolini] Financial incentives in primary care have been introduced with the purpose of improving appropriateness of care and containing demand. We usually observe pay-for-performance programs, but alternatives, such as pay-for-participation in improvement activities and pay-for-compliance with clinical guidelines, have also been implemented. Here, we assess the influence of different programs that ensure extra payments to GPs for containing avoidable hospitalisations. Our dataset covers patients and GPs of the Italian region Emilia-Romagna for the year 2005. By separating pay-for-performance from pay-for-participation and pay-for-compliance programs, we estimate the impact of different financial incentives on the probability of avoidable hospitalisations. As dependent variable, we consider two different sets of conditions for which timely and effective primary care should be able to limit the need for hospital admission. The first is based on 27 medical diagnostic related groups that Emilia-Romagna identifies as at risk of inappropriateness in primary care, while the second refers to the internationally recognised ambulatory care-sensitive conditions. We show that pay-for-performance schemes may have a significant effect over aggregate indicators of appropriateness, while the effectiveness of pay-for-participation schemes is adequately captured only by taking into account subpopulations affected by specific diseases. Moreover, the same scheme produces different effects on the two sets of indicators used, with performance improvements limited to the target explicitly addressed by the Italian policy maker. This evidence is consistent with the idea that a "tunnel vision” effect may occur when public authorities monitor specific sets of objectives as proxies for more general improvements in the quality of health care delivered. Springer-Verlag, 2010 Primary care nationallicence Preventable hospitalisation nationallicence Financial incentive nationallicence Organizational appropriateness nationallicence Multilevel modelling nationallicence Fiorentini Gianluca Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut Iezzi Elisa Department of Statistics, University of Bologna, Via Belle Arti, 41, 40126, Bologna, Italy aut Lippi Bruni Matteo Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut Ugolini Cristina Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut The European Journal of Health Economics Springer-Verlag 12/4(2011-08-01), 297-309 1618-7598 12:4<297 2011 12 10198 https://doi.org/10.1007/s10198-010-0230-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10198-010-0230-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Fiorentini Gianluca Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut NATIONALLICENCE 700 1- Iezzi Elisa Department of Statistics, University of Bologna, Via Belle Arti, 41, 40126, Bologna, Italy aut NATIONALLICENCE 700 1- Lippi Bruni Matteo Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut NATIONALLICENCE 700 1- Ugolini Cristina Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy aut NATIONALLICENCE 773 0- The European Journal of Health Economics Springer-Verlag 12/4(2011-08-01), 297-309 1618-7598 12:4<297 2011 12 10198 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer