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The impact of a French experiment on doctor-nurse cooperation on general practitioner activity

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2019. Sujet(s) : Ressources en ligne : Abrégé : In many countries, policies and reforms have explicitly encouraged the integration of primary care organizations and interprofessional cooperation in order to improve the productive and allocative efficiency of care provision and to address the unequal geographical distribution of doctors. In France, the Social Security Department of the Ministry of Health and a nonprofit organization called Asalée ( Action de santé libérale en équipe; Team Health Project in Private Practice) set up an experiment to promote vertical integration and teamwork between general practitioners (GPs) and nurses, based in particular on the staffing and training of nurses, as well as the authorization of task substitution between general practitioners and nurses, and new forms of remuneration. This article evaluates the expansion of this experiment over the period 2010–2016 by studying the joint effect on GPs’ activity of the cooperation between general practitioners and nurses, the specific organization of Asalée, and the underlying economic incentives. GPs’ activity was based on the following indicators: number of working days, number of different patients seen at least once (active file) and, among them, those who listed the GP as their treating physician, and the number of appointments carried out (either in the consultation room or at the patient’s home). We control, as much as possible, for endogeneity and selection biases by using a case-control design, consisting of exact matching methods and difference-in-differences estimations on panel data. We highlight a positive but relatively modest effect of the Asalée pilot on GPs’ number of working days (+1.2%) and a more pronounced effect on the number of patients seen (+7.55%) or listing the GP as their attending physician (+6.87%). Yet, we find no effect on the number of consultations or home visits. JEL codes: C31, C33, I11, J22, L23
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In many countries, policies and reforms have explicitly encouraged the integration of primary care organizations and interprofessional cooperation in order to improve the productive and allocative efficiency of care provision and to address the unequal geographical distribution of doctors. In France, the Social Security Department of the Ministry of Health and a nonprofit organization called Asalée ( Action de santé libérale en équipe; Team Health Project in Private Practice) set up an experiment to promote vertical integration and teamwork between general practitioners (GPs) and nurses, based in particular on the staffing and training of nurses, as well as the authorization of task substitution between general practitioners and nurses, and new forms of remuneration. This article evaluates the expansion of this experiment over the period 2010–2016 by studying the joint effect on GPs’ activity of the cooperation between general practitioners and nurses, the specific organization of Asalée, and the underlying economic incentives. GPs’ activity was based on the following indicators: number of working days, number of different patients seen at least once (active file) and, among them, those who listed the GP as their treating physician, and the number of appointments carried out (either in the consultation room or at the patient’s home). We control, as much as possible, for endogeneity and selection biases by using a case-control design, consisting of exact matching methods and difference-in-differences estimations on panel data. We highlight a positive but relatively modest effect of the Asalée pilot on GPs’ number of working days (+1.2%) and a more pronounced effect on the number of patients seen (+7.55%) or listing the GP as their attending physician (+6.87%). Yet, we find no effect on the number of consultations or home visits. JEL codes: C31, C33, I11, J22, L23

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