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The European Journal of Health Economics

, Volume 17, Issue 6, pp 723–732 | Cite as

The true impact of the French pay-for-performance program on physicians’ benzodiazepines prescription behavior

  • Audrey Michel-LepageEmail author
  • Bruno Ventelou
Original Paper

Abstract

Objectives

The French pay-for-performance (P4P) contract CAPI implemented by the national health insurance included a target-goal which aims at reducing benzodiazepines prescriptions. In this investigation, we would like to assess whether: (1) the general practitioners (GPs) having signed P4P contract obtain better results regarding the target-goal than non-signatories; (2) (part of) this progression is due to the CAPI contract itself (tentative measurement of a “causal effect”); (3) (part of) the money spent on this P4P incentive can be self-financed with the amount of pharmaceuticals saved.

Methods

We matched cross-sectional and longitudinal data including 4622 French GPs from June 2011 to December 2012. A treatment effect model using instrumental variables was performed to take into account potential self-selection issue in signing. After having identified the NET impact of the P4P, we calculate the cost of an avoided benzodiazepines treatment.

Results

In our study, GPs who have signed the CAPI contract (36 % of the sample) are more numerous in achieving benzodiazepines target goal than non-signatories: 90.7 vs. 85.5 %. After controlling for the self-selection bias, the propensity of GPs to achieve the benzodiazepines target is only 0.31 % higher for signatories than for their non-signing counterparts—estimate for June 2012, which yields a statistically significant gap. Our economic analysis demonstrates that the CAPI contract does not allow savings, but presents in 2012 a NET cost of 93.6€ per avoided benzodiazepines treatment (291€ in 2011).

Conclusions

The P4P contract has a positive but modest impact on the achievement of GPs regarding benzodiazepines indicator.

Keywords

Pay-for-performance CAPI Benzodiazepines General practitioners Behaviors 

JEL Classification

I110 

Notes

Acknowledgments

We thank the health care administration (Caisse Primaire d’Assurance Maladie) for having provided us the databases according to the CNIL authorization, and the Regional Health Agency (Agence Régionale de Santé) for having delivered us the anonymous identity of southeastern GPs.

A.M- L. received a PhD grant from the “Méditerranée Infection” foundation (a non-profit-making foundation, http://www.mediterranee-infection.com/). The authors benefit from the financial support of the Agence Nationale de Sécurité du Medicament et des produits de santé (ANSM) in the context of a research-platform in pharmacoepidemiology created in 2014. Warning: the content of this article commits only the authors and does not reflect necessarily the position of the health authority. None of the above bodies had any role in study design; the collection, analysis, and interpretation of data; the writing of the paper; or the decision to submit this paper for publication.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Aix Marseille Université (Aix Marseille School of Economics, SESSTIM UMR912)MarseilleFrance
  2. 2.Aix Marseille Université (Aix Marseille School of Economics, GREQAM UMR7316)MarseilleFrance
  3. 3.ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’AzurMarseilleFrance
  4. 4.IHU, Fondation Méditerranée InfectionMarseilleFrance

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