Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
Centre for Health Economics, University of York, York, UK.
Health Econ. 2023 Feb;32(2):343-355. doi: 10.1002/hec.4623. Epub 2022 Oct 30.
A largely unexplored part of the financial incentive for physicians to participate in preventive care is the degree to which they are the residual claimant from any resulting cost savings. We examine the impact of two preventive activities for people with serious mental illness (care plans and annual reviews of physical health) by English primary care practices on costs in these practices and in secondary care. Using panel two-part models to analyze patient-level data linked across primary and secondary care, we find that these preventive activities in the previous year are associated with cost reductions in the current quarter both in primary and secondary care. We estimate that there are large beneficial externalities for which the primary care physician is not the residual claimant: the cost savings in secondary care are 4.7 times larger than the cost savings in primary care. These activities are incentivized in the English National Health Service but the total financial incentives for primary care physicians to participate were considerably smaller than the total cost savings produced. This suggests that changes to the design of incentives to increase the marginal reward for conducting these preventive activities among patients with serious mental illness could have further increased welfare.
医生参与预防保健的经济激励的一个很大程度上未被探索的部分是他们从任何由此产生的成本节约中获得剩余索取权的程度。我们通过英国初级保健实践，考察了针对严重精神疾病患者的两种预防活动（护理计划和身体健康年度审查）对这些实践和二级保健成本的影响。我们使用面板二分模型分析了初级保健和二级保健之间相互关联的患者层面数据，发现这些预防活动在前一年与当前季度的初级保健和二级保健成本降低有关。我们估计存在很大的有益外部性，而初级保健医生并不是剩余索取权人：二级保健的成本节约是初级保健的 4.7 倍。这些活动在英国国民保健制度中有激励措施，但参与的初级保健医生的总经济激励措施远远小于产生的总成本节约。这表明，为提高对严重精神疾病患者开展这些预防活动的边际奖励而改变激励措施的设计，可以进一步提高福利。
