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General Practitioners' income and activity: the impact of Multi-professional Group Practice in France

Mardi 4 juin 2019

Séminaire en français

Cassou M. (CESP, Inserm), Mousquès J. (Irdes, CESP), Franc C. (CESP-Inserm UMR 1018, Irdes)

Objectives: France has created an innovative additional payment to promote coordination related to Multi-professional Group Practice (MGP). Cooperation and teamwork are intended to improve both the efficiency of health care provision and the attractiveness of underserved areas for health professionals. To evaluate the sustainability of this type of organization in terms of practitioners' satisfaction we analyze the evolution of medical earnings (self-employed fees and salaries) for GPs enrolled in a MGP. We also study its impact on medical activity through the number of patients encountered and the quality of care provided according to their results in the French P4P system.

Methods: We use an exhaustive administrative database from the Public Fund on self-employed doctors' medical activities, and from household tax returns, their earnings and family structure for 2005, 2008, 2011 and 2014. We use a case-control design with coarsened exact matching (CEM) and difference-in-differences (DID) estimation on panel data to improve our control confounders and limit the exposure of our analyses to specification bias. The CEM is made for the year 2008, the pre-policy period, based on socio-demographic and geographical location variables that are known to affect GP's activities and incomes (2005 data are only used for pre-trend and robustness checks). The DID parameters are estimated by both pooled OLS and Fixed Effects between 2008 and 2014, on the GPs' incomes and the number of patients encountered at least once. Finally, we conduct a cross-sectional analysis of P4P payment in 2014, assess MGPs' impact on the quality of care.

Results: Over the 2008-2014 period, GPs working in MGPs exhibit an increase in income 3% higher (about € 2,500) to that of their controls. Difference in their income growth is mainly driven by a much larger increase in their self-employed income (more than 80%). Besides, the enrolment into a MGPs increase the size of the GPs' patient list: the number of patients they have seen at least once per year increased by on average 4% (about 80 patients) more than their peers over the period. In addition, the analysis of P4P payments for GPs in 2014 shows that GPs practicing in MGP received 900 euros (+12%) more than their control.

Discussion: Due to a larger size and potential higher charges compared to solo practices, it was unclear that MGPs could be attractive for GPs in the long run regarding their net income. Our preliminary results suggest that medical revenue issues shouldn't be a barrier to the development of MGPs. On the contrary, it should be an attractive practice for new GPs. Moreover, these practices appear to favor a greater availability of GPs for a larger number of patients, and the quality also appears to be enhanced.



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