OBJECTIVES: A new incentive scheme was introduced for Danish general practitioners (GP) in 2018 aiming to increase responsibility for type 2 diabetes (T2D) management. GPs received a large new capitation payment covering basic consultation services, while other services remained compensated by fee-for-service (FFS). We investigate the scheme’s uptake and impacts on service delivery.

METHODS: Using administrative databases, we identified T2D patients and determined whether or not they were likely to be profitable 'low-need/use' under the new incentive scheme. We identified when patients were enrolled, and analysed monthly service provision using balanced panels with patient-level fixed effects models.

RESULTS: We considered 239,776 T2D exclusively GP-monitored patients between 2015 and 2019. 72% were identified as profitable ‘low-need/use’ patients, tending to be younger and healthier. However, enrollment was faster within the unprofitable ‘high-need/use’ patients, indicating that GPs were not selecting against their inclusion. By the end of 2018, 39% were enrolled, rising to 59% by the end of 2019. Incentive associated impact on monthly rate of FFS services provided was positive for ‘low-need/use’ patients (0.158, p<0.001) and unnoticeably changed for high-need/use patients (-0.011, p<0.001). The associated monthly impact on capitated services provided was positive for ‘low-need/use’ patients (0.128, p<0.001), but negative for ‘high-need/use’ patients (-0.187, p<0.001).

CONCLUSIONS: This study finds evidence that the enrollment of T2D patients in a new primary care incentive scheme was associated with greater provision of services for ‘low-need/use’ patients, while ‘high-need/use’ patients receiving fewer consultations but a similar level of services which remained compensated on a FFS basis. It is unclear whether this reflects a reduction of care quality or an increase in the efficiency of provided consultations. New financial incentives may simultaneously improve care delivery for least demanding chronic disease patients while detracting from care delivery for highest needs patients. Careful monitoring of health outcomes is necessary to assess the balance.