Discussion and Conclusion

fees. However, the increased number of patients led to an increased workload for physicians. In addition, the increase in fees is smaller than the rise in activity. Suppose all physicians reached all their objectives imposed by the contracts, the improvement in access to care is costly for the NHI. Regarding benefits and costs, the balance is negative: the NHI spent more than on average e5 to avoide1 of extra fees. Therefore, introducing financial incentives has generated a transfer of the payment of extra fees from the patients to the community (the NHI).

This paper estimates a short-term effect of the CAS and the OPTAM on physicians’ activity. One of the main assumptions is that physicians directly react once they decide to join the programs.

However, the NHI gave them information about their activity during the registration (and also to convince them to join it), informed them every trimester about their progression, and advised them on how to reach their goals in terms of overbilling rates especially. Therefore, seeing them try to achieve their objectives would not be surprising. Furthermore, I only estimate the effect of the programs on the volume of care rather than on the quality. Indeed, I need the information on consultation length and waiting time to do so: if the supply side was already constrained, increasing their workload could decrease the quality of care (more office visits performed in a given time). Finally, The CAS and the OPTAM also had unintended effects: a non-negligible number of eligible sector 1 physicians chose to join the programs and can now overbill: the total share of activity proposed to the population at regulated prices has therefore decreased. Further investigations on sector 1 physicians’ adhesion to these programs and the consequences on access to care at regulated prices for the population is, therefore, necessary and left for future research.

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