Effect of pay-for-performance on cervical cancer screening participation in France

  • Panayotis ConstantinouEmail author
  • Jonathan Sicsic
  • Carine Franc
Research Article


Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006–2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.


Pay for performance Cervical cancer screening Preventive health services Primary health care France 

JEL Classification

I18 C23 



For this research we benefited from grants provided by the French National Cancer Institute (INCa) and by the “Cancéropôle île-de-France”.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was not required for this study as all data were anonymized.

Supplementary material

10754_2016_9207_MOESM1_ESM.docx (44 kb)
Supplementary material 1 (docx 43 KB)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.INSERM, Centre for Research in Epidemiology and Population HealthUniversité Paris-Saclay, Université Paris-Sud, UVSQVillejuif CedexFrance

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