Health care providers may engage in gaming if they self-report their performance against the targets on which they are monitored, regulated or rewarded. We examine how family doctors in England responded to a temporary but substantial increase in 2013 in the stringency of the targets that governed their payments for ensuring younger patients diagnosed with hypertension had controlled blood pressure. We apply difference-in-differences and bunching techniques to data from the electronic health records of 65,670 individuals aged under 80 years and 17,509 individuals aged 80 and over between 2010 and 2016. We find that doctors did not diagnose different numbers or types of patients.
They did increase treatment intensity, with a 1.2 percentage point increase in probability of any medication. They also undertook more blood pressure measurement, with the probability of having multiple tests increasing by 1.9 percentage points overall and by 8.8 percentage points if the first reading failed the more stringent target. Doctors also exempted more patients from their reported performance (by 0.8 percentage points) and they increased very substantially the proportion of patients recorded as exactly achieving the more stringent blood pressure target (by 11.9 percentage points).
These results suggest that doctors will both respond as intended and game when set more stringent performance targets under financial incentives.
Speaker: Matt Sutton, University of Manchester.
Matt Sutton has been a Professor of Health Economics at the University of Manchester since 2008. He previously worked at the Universities of Aberdeen, Glasgow, York, New South Wales and Lund and was previously an Economic Advisor in the Scottish Executive Health Department. His work focuses on the organisation and financing of health care, inequalities in health and health behaviours, and the health care workforce. He is a National Institute for Health and Care Research Senior Investigator, an Associate Editor of Health Economics, and has been a member of several funding and fellowship committees.
Meeting ID: 986 1669 3087
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