Brown Bag Seminar: GP incentives for diabetes prevention and management in Italy

This study evaluates the impact of a disease management plan (DMP) incentive program targeting cardiovascular risk factors—specifically diabetes—implemented across three Local Health Units (LHUs) in Italy. The analysis follows roughly 200 general practitioners for a period of 9 years, with the cohorts of observation defined at the doctor × patient birth year × year level. We begin with an event-study design, adjusting for pre-trends, to capture the dynamic effects of the program’s introduction in 2014. Identification is further strengthened by exploiting the age eligibility threshold—patients aged 65 and above—within a Regression Discontinuity Design (RDD) framework centered on the introduction of incentives. Our early results focus on three main outcomes: (i) the percentage of patients diagnosed with diabetes within each GP–birth cohort–year cell, (ii) the number of per-patient antidiabetic prescriptions across cohorts, and (iii) the number of per-patient glycated hemoglobin (HbA1c) screenings. The event-study analysis shows weakly positive effects of the incentive program on all three outcomes; however, pre-trends are likely to bias these estimates, which we address by adjusting for pre-trend residuals. However, our RDD analysis comparing the pre- and post-treatment periods (difference-in-discontinuities) finds no significant effect of the program on any of the outcomes, and no significant change in the RDD coefficients before and after the 2014 introduction of the incentives.