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

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Abstract

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.

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Notes

  1. Women under a specific scheme (Affection Longue Durée, ALD) administered by the national health insurance, that waives copayments related to the treatment of specific chronic conditions.

  2. The use of a fixed-effects estimator was not possible due to the existence of time-invariant information such as area of residence. Indeed, 96% of included women did not change area of residence during our study period. These analyses were conducted as robustness analyses and the discussion about the choice between fixed or random effects for longitudinal analysis falls out of the scope of our work.

  3. Data collection methods can also be more or less within provider’s control: we note in Table 1S that some chronic disease management indicators concern outcome measures and that achievement rate is based upon physician self-report. Achievement increased for these indicators even though outcome measures are supposedly harder to achieve than process measures.

  4. We thank the French national health insurance (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, CNAMTS) for giving us access to unpublished achievement data.

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Acknowledgements

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

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  1. INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France

    Panayotis Constantinou, Jonathan Sicsic & Carine Franc

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  1. Panayotis Constantinou
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Correspondence to Panayotis Constantinou.

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Constantinou, P., Sicsic, J. & Franc, C. Effect of pay-for-performance on cervical cancer screening participation in France. Int J Health Econ Manag. 17, 181–201 (2017). https://doi.org/10.1007/s10754-016-9207-3

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