Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes
中文摘要
多年来，由医生持有英格兰全科诊所所有权的比例持续下降，并日益集中于少数医生手中。非临床所有权可能为全科医疗提供一种可持续的替代结构。本研究首次对英格兰全科医疗背景下的非临床所有权进行了正式评估。我们从多种来源汇编了 2015/16 至 2022/23 八年间全科诊所的综合数据集，以考察非临床股权对初级保健关键结果的影响，包括人员配置水平与流动率、患者满意度、可及性、医疗质量、非核心服务的报销以及在册患者总数。采用动态事件研究设计并结合倾向得分加权，我们发现诊所经理合伙人会增加直接患者护理（不含医生和护士）人员、行政人员数量、非核心服务报销以及在册患者总数。然而，我们发现对其他任何结果均无统计显著的效应。向非医生员工提供股权，或可通过允许替代性所有权结构来支持诊所的可持续性。
Abstract
Ownership of English general practices by physicians has been declining for many years and concentrated among fewer physicians. Non-clinical ownership may provide a sustainable alternative structure for general practice. In this study, we provide the first formal evaluation of non-clinical ownership in an English general practice setting. We compile a comprehensive dataset of general practices across eight years between 2015/16 and 2022/23 from a range of sources to investigate the impact of non-clinical ownership stakes on key primary care outcomes, including staffing levels and turnover, patient satisfaction, access, quality of care, reimbursement for non-core services and total patient list size. Employing a dynamic event study design combined with propensity-score weighting, we find practice manager partners increase direct patient care (excluding physicians and nurses), administrative staff numbers, reimbursement for non-core services and total patient list size. However, we find no statistically significant effect on any other outcome. Offering equity stakes to non-physician staff may support practice sustainability by allowing alternative ownership structures.