Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data
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.
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.
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).
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.
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.
KeywordsBreast cancer screening Difference-in-difference Incentives Pay for performance Primary care
JEL ClassificationC35 I18
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).
Compliance with ethical standards
Conflict of interest
- 1.Scott, A., Sivey, P., Ait Ouakrim, D., Willenberg, L., Naccarella, L., Furler, J., Young, D.: The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst. Rev. CD008451. doi: 10.1002/14651858
- 7.Commission des Comptes de Sécurité Sociale: Le contrat d’amélioration des pratiques individuelles (CAPI). http://www.securite-sociale.fr/IMG/pdf/fiche_eclairage_maladie_capi_sept_2011.pdf (2011). Accessed 20 June 2016
- 10.Ryan, A., Sutton, M., Doran, T.: Does winning a pay-for-performance bonus improve subsequent quality performance? Evidence from the hospital quality incentive demonstration. Health Serv. Res. 49, 568–587 (2014)Google Scholar
- 14.Sabatino, S.A., Lawrence, B., Elder, R., Mercer, S.L., Wilson, K.M., DeVinney, B., Melillo, S., Carvalho, M., Taplin, S., Bastani, R., Rimer, B.K., Vernon, S.W., Melvin, C.L., Taylor, V., Fernandez, M., Glanz, K.: Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am. J. Prev. Med. 43, 97–118 (2012)CrossRefPubMedGoogle Scholar
- 17.Frey, B.: Not Just for the Money: An Economic Theory of Personal Motivation. Edward Elgar, Cheltenham, Brookfield (1997)Google Scholar
- 19.Sicsic, J., Le Vaillant, M., Franc, C.: Intrinsic and extrinsic motivations in primary care: An explanatory study among French general practitioners. Health Policy Amst. Neth. 108, 140–148 (2012)Google Scholar
- 26.Franc, C., Lesur, R.: Systèmes de rémunération des médecins et incitations à la prévention. Rev. Économique. 55, 901–922 (2004)Google Scholar
- 33.Givord, P.: Insee—Document recherche—Méthodes économétriques pour l’évaluation de politiques publiques. Série des documents de travail de la Direction des Etudes et Synthèses Economiques. http://www.insee.fr/fr/publications-et-services/docs_doc_travail/G2010-08.pdf (2010). Accessed 20 June 2016
- 38.Sabatino, S.A., Habarta, N., Baron, R.C., Coates, R.J., Rimer, B.K., Kerner, J., Coughlin, S.S., Kalra, G.P., Chattopadhyay, S.: Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives. Am. J. Prev. Med. 35, S67–S74 (2008)CrossRefPubMedGoogle Scholar