ERUDITE (EA 437), FR TEPP CNRS 3435, University Paris-Est Créteil (UPEC), Créteil, France.
Institute for Research and Information in Health Economics (Irdes), Paris, France.
Health Econ. 2021 Mar;30(3):680-698. doi: 10.1002/hec.4214. Epub 2020 Dec 29.
The integration of primary care organizations and interprofessional cooperation is encouraged in many countries to both improve the productive and allocative efficiency of care provision and address the unequal geographical distribution of general practitioners (GPs). In France, a pilot experiment promoted the vertical integration of and teamwork between GPs and nurses. This pilot experiment relied on the staffing and training of nurses; skill mixing, including the authorization to shift tasks from GPs to nurses; and new remuneration schemes. This article evaluates the overall impact of this pilot experiment over the period 2010-2017 on GP activities based on the following indicators: number of working days, patients seen at least once, patients registered, and visits delivered. We control for endogeneity and reduce selection bias by using a case-control design combining coarsened exact matching and difference-in-differences estimates on panel data. We find a small positive impact on the number of GP working days (+1.2%) following enrollment and a more pronounced effect on the number of patients seen (+7.55%) or registered (+6.87%). However, we find no effect on the number of office and home visits. In this context, cooperation and teamwork between GPs and nurses seem to improve access to care for patients.
许多国家都鼓励初级保健组织的整合和跨专业合作，以提高医疗服务的生产效率和分配效率，并解决全科医生（GP）地理分布不均的问题。在法国，一项试点实验促进了全科医生和护士之间的垂直整合和团队合作。该试点实验依赖于护士的人员配置和培训；技能混合，包括授权将任务从全科医生转移到护士；以及新的薪酬计划。本文基于以下指标，评估了 2010-2017 年期间该试点实验对全科医生活动的总体影响：工作天数、至少见过一次的患者人数、注册患者人数和提供的就诊次数。我们通过使用案例对照设计，结合面板数据的粗化精确匹配和差异中的差异估计，控制了内生性并降低了选择偏差。我们发现注册后全科医生的工作天数（增加 1.2%）略有增加，而看诊或注册患者的人数（增加 7.55%或 6.87%）的增加更为明显。然而，我们没有发现对门诊和家访次数的影响。在这种情况下，全科医生和护士之间的合作和团队合作似乎改善了患者的医疗服务可及性。
