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Home sweet home: GPs’ response to an increase in the fee size for home visits

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Abstract

In many health care systems GPs receive fees for their services. Policymakers may use the size of these fees to try to incentivise GPs to provide more care. However, evidence is mixed on whether and how GPs respond to an increase in the fee size. This study investigates how GPs respond to an average increase of 150% in the fee for a high-effort and infrequent service such as a home visit due to patients’ illness. We consider Danish GPs’ provision of these visits to enlisted patients living outside of nursing homes. Using linear regressions with general practice fixed effects and a rich number of control variables, we estimate the association between GPs’ provision of these home visits and the fee rise. On average, we find no association between the fee rise and GPs’ provision of home visits. However, we find that GPs who previously provided the fewest home visits to eligible patients increase their provision by 13% after the fee rise compared to other GPs. This increase in visits is driven by more patients receiving multiple visits after the fee rise. We conclude that a fee rise may not yield a strong response in GPs’ provision of high-effort and infrequent services such as home visits.

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Availability of data and material

The data used in this paper are from pseudonymised register data held by Statistics Denmark. The data is confidential and person identifiable. Thus, we are unable to make any of the data publicly available.

Code availability

All analyses were conducted using STATA 15. The code used remains on the secure server where all the data are stored.

Notes

  1. A regular practice consultation yields a consultation fee of around €20.

  2. As we only know the year patients move to a nursing home, we assume that all visits to these patients in the year of the move are to a nursing home. Thus, we are likely overestimating the number of nursing home visits.

  3. We define being active as having billed for services each year during our analysis period.

  4. The DREAM database includes information on public transfer payments and employment status.

  5. We also investigated whether differences in enlisted patients over 75 years olds mortality rates across practices could be driving our findings for this indicator. Appendix 4 shows no significant differences in death rates across the subgroups of GPs. The observed increase in mortality rate across GPs in 2016 may be explained by a hard flu season, which led to an increase in mortality among frail patients [22].To further support that mortality rates are not driving our findings, we find that our results are robust to controlling for mortality rates of enlisted patients over 75 years olds (see appendix 4).

  6. One could also argue that a high activity level per enlisted patient could reflect abundant resources. However, as we in our analysis include a large array of controls, including the number of patients on the GPs’ list and their case-mix, we find it likely that the higher activity per patient over and above these factors is a measure of pressure on resources.

  7. See the definition of this baseline group in the above presentation of each heterogeneity indicator.

  8. As we include practice fixed effects, our baseline year (2015) is independent of each subgroup’s average service provision.

  9. We do not control for this variable in the heterogeneity analysis where we group the GPs based on their average revenue per enlisted patient in the previous year.

  10. A regular practice consultation yields a consultation fee of around €20.

  11. The findings for the outcome “the number of inpatient hospitalisations” is available upon request.

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Acknowledgements

We are grateful to the Novo Nordisk Foundation (Grant number: NNF18OC0033978) and the European Union’s Framework Programme for Research and Innovation Horizon 2020 (Grant number: 721402) for financial support. We also wish to thank Nicolai Fink Simonsen for help with constructing the data set and Luigi Siciliani, Pedro Pita Barros, Nils Gutacker, Karsten Vrangbæk, and Mauro Laudicella for useful comments and feedback. Any remaining errors are the authors’ responsibility.

Funding

This work was supported by the Novo Nordisk Foundation (Grant number: NNF18OC0033978) and the European Union’s Framework Programme for Research and Innovation Horizon 2020 (Grant number: 721402).

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Authors and Affiliations

  1. Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense, Denmark

    Jamie O’Halloran, Anne Sophie Oxholm, Line Bjørnskov Pedersen & Dorte Gyrd-Hansen

  2. Research Unit for General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense, Denmark

    Line Bjørnskov Pedersen

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  1. Jamie O’Halloran
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  2. Anne Sophie Oxholm
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Correspondence to Jamie O’Halloran.

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O’Halloran, J., Oxholm, A.S., Pedersen, L.B. et al. Home sweet home: GPs’ response to an increase in the fee size for home visits. Eur J Health Econ 22, 977–989 (2021). https://doi.org/10.1007/s10198-021-01302-3

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