Compliance with Clinical Guidelines: The role of incentives and competition between practitioners
In this study we use a unit record, panel dataset, to examine the behaviour of clinicians under a chronic disease management program (CDMP) that is designed to improve care and slow the progression of chronic kidney disease (CKD). Using eight years of quarterly data on the population of CKD patients (n=44,686) in the Emilia-Romagna region of northern Italy, we analyse a setting where medical practitioners are agents who respond to the demands of two principals: their patient and the third-party payer. Exploiting detailed information on specialist visits and the concentration of general practitioners (GP) in local areas, as well as disease severity, we study how GPs on one side, and specialist nephrologists and cardiologists on the other comply with the CDMP guidelines, as may be predicted on the basis of a dual-agency approach. Our application of both multiple-treatment differences-in-differences (DIDM) and panel fixed-effects linear probability models produces evidence coherent with income-maximizing and, to a lower extent, effort-reducing strategies on the part of the GPs, as well as with strategic behaviour by some specialists. We also produce evidence that specialists who practice in hub facilities with a leading role in CDMP implementation, also for reputational reasons, exhibit referral practices that are more closely related to the CDMP guidelines.
Speaker profile
Luke Connelly is Professor of Health Economics at The University of Queensland’s Centre for the Business and Economics of Health and Professor of Public Health (part-time) at the University of Bologna’s Department of Sociology and Business Law. His primary interests are in health economics, insurance economics, and applied econometrics.
Weekly seminar series
As part of our Centre's vibrant research culture, we host a weekly seminar series. Visiting and invited researchers present current research relating to the economics of health and wellbeing, and the healthcare sector. Visitors are welcome to join these sessions where discussion and debate is encouraged.
For further information on our seminar series, please contact Trong-Anh.Trinh@monash.edu.
Event Details
- Date:
- 12 March 2025 at 12:00 pm – 1:15 pm
- Venue:
- Caulfield campus, Building H, level 8, room H8.13
- Categories:
- CHE Seminar; General
Description
In this study we use a unit record, panel dataset, to examine the behaviour of clinicians under a chronic disease management program (CDMP) that is designed to improve care and slow the progression of chronic kidney disease (CKD). Using eight years of quarterly data on the population of CKD patients (n=44,686) in the Emilia-Romagna region of northern Italy, we analyse a setting where medical practitioners are agents who respond to the demands of two principals: their patient and the third-party payer. Exploiting detailed information on specialist visits and the concentration of general practitioners (GP) in local areas, as well as disease severity, we study how GPs on one side, and specialist nephrologists and cardiologists on the other comply with the CDMP guidelines, as may be predicted on the basis of a dual-agency approach. Our application of both multiple-treatment differences-in-differences (DIDM) and panel fixed-effects linear probability models produces evidence coherent with income-maximizing and, to a lower extent, effort-reducing strategies on the part of the GPs, as well as with strategic behaviour by some specialists. We also produce evidence that specialists who practice in hub facilities with a leading role in CDMP implementation, also for reputational reasons, exhibit referral practices that are more closely related to the CDMP guidelines.
Speaker profile
Luke Connelly is Professor of Health Economics at The University of Queensland’s Centre for the Business and Economics of Health and Professor of Public Health (part-time) at the University of Bologna’s Department of Sociology and Business Law. His primary interests are in health economics, insurance economics, and applied econometrics.
Weekly seminar series
As part of our Centre's vibrant research culture, we host a weekly seminar series. Visiting and invited researchers present current research relating to the economics of health and wellbeing, and the healthcare sector. Visitors are welcome to join these sessions where discussion and debate is encouraged.
For further information on our seminar series, please contact Trong-Anh.Trinh@monash.edu.