Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden

Abstract

This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Using provider-level outcome data for 2005–2013 from the Swedish Prescription Register, providers in regions using P4P were compared to providers in other regions in a difference-in-differences analysis. The results indicate that P4P improved guideline compliance regarding prescription of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. The effect was mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers. Electronic supplementary material The online version of this article (10.1007/s10754-020-09278-y) contains supplementary material, which is available to authorized users.

Exploring differences between public and private providers in primary care: findings from a large Swedish region

“…Contrary to the findings by Maun et al (2015), public PCCs also adhered better to prescription guidelines regarding harmful drugs for elderly in the studied region. This result also differs from findings by Ellegård (2020) who found that private PCCs adhered better to prescription guidelines compared to public PCCs in Sweden. However, compliance with guidelines was linked to financial incentives in pay-for-performance schemes in the study by Ellegård (2020).…”

“…This result also differs from findings by Ellegård (2020) who found that private PCCs adhered better to prescription guidelines compared to public PCCs in Sweden. However, compliance with guidelines was linked to financial incentives in pay-for-performance schemes in the study by Ellegård (2020). One interpretation, in line with theoretical assumptions about differences across owner types (Kornai et al, 2003;Frey et al, 2013), is that monetary incentives are stronger for private (for-profit) than public providers.…”

“…Theoretically, public providers have weaker incentives to perform efficiently as they are not accountable to shareholders and often face softer budget constraints compared to private (for-profit) providers (Kornai et al, 2003). Motivation might also differ between private and public employees, where the latter may rely more on intrinsic motivation for their work, implying that external controls, e.g., financial incentives, may have less impact in public organisations (Georgellis et al, 2011;Frey et al, 2013;Ellegård, 2020). On the other hand, if public and private providers face similar principles of governance and other conditions, such differences might be reduced.…”

Can Private Provision of Primary Care Contribute to the Spread of Antibiotic Resistance? A Study of Antibiotic Prescription in Sweden

“…Granlund [ 15 ] found that private doctors were more likely to disallow generic substitution. More recently, Ellegård [ 16 ] studied how pay-for-performance incentives affected primary care providers’ compliance with hypertension drug guidelines and found that private providers reacted more strongly to the economic incentives. To our knowledge, there are no studies to date addressing the impact of ownership of healthcare centres on the prescription of antibiotics.…”

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

“…The authors did not find any indications of gaming by prescribing more antibiotics overall to increase the share of narrow-spectrum antibiotics. Furthermore, Ellegård [ 35 ] examined the effect of P4P on compliance with hypertension drug guidelines among public and private healthcare providers. The results showed that P4P incentives had a significant effect on guideline compliance and that the effect was most noticeable for private providers, indicating that private providers are more responsive towards financial incentives.…”