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Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data

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Abstract

Background

A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP.

Objective

Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old.

Methods

Based on an administrative database of 50,752 women aged 50–74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use).

Results

Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41–2.35 %)], but the effect was not significantly different following the implementation of the contract.

Conclusion

The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.

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Notes

  1. The referral doctor scheme (“dispositif médecin traitant”) was introduced in France in 2005. Each insured patient must appoint a doctor (a generalist or other doctor), whose role is to update the patient’s medical record, coordinate his/her care pathway and centralize other caregiver notices. In the case of non-compliance with the referral doctor’s pathway, the patient must pay non-refundable penalties. In 2011, 90 % of insured patients had selected a referral doctor, and 95 % of them had appointed a GP (Annual Report of the Audit Court, 2013).

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Acknowledgments

We are indebted to the Caisse Nationale d’Assurance Maladie des Travaileurs Salariés (CNAMTS) for giving access to the data. For this research we benefited from grants provided by the Canceropôle and the National Institute for Cancer (INCa).

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Authors and Affiliations

  1. CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France

    Jonathan Sicsic & Carine Franc

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  1. Jonathan Sicsic
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  2. Carine Franc
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Correspondence to Jonathan Sicsic.

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Appendices

Appendix 1

See Table 4.

Table 4 Description of CAPI indicators
Full size table

Appendix 2

See Table 5.

Table 5 Results of the multivariate probit models
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Sicsic, J., Franc, C. Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. Eur J Health Econ 18, 609–621 (2017). https://doi.org/10.1007/s10198-016-0813-2

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