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Soc Sci Med. 2015 Jan;124:18-28. doi: 10.1016/j.socscimed.2014.11.001. Epub 2014 Nov 5.

Paying for primary care: a cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada.

Author information

1
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Canadian Centre for Health Economics, Canada. Electronic address: david.rudoler@utoronto.ca.
2
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Canadian Centre for Health Economics, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada.
4
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Centre for Research on Inner City Health, and St. Michael's Hospital, Ontario, Canada; Family and Community Medicine, University of Toronto and St. Michael's Hospital, Canada.

Abstract

Policy-makers desire an optimal balance of financial incentives to improve productivity and encourage improved quality in primary care, while also avoiding issues of risk-selection inherent to capitation-based payment. In this paper we analyze risk-selection in capitation-based payment by using administrative data for patients (n = 11,600,911) who were rostered (i.e., signed an enrollment form, or received a majority of care) with a primary care physician (n = 8621) in Ontario, Canada in 2010/11. We analyze this data using a relative distribution approach and compare distributions of patient costs and morbidity across primary care payment models. Our results suggest a relationship between being in a capitation-based payment scheme and having low cost patients (and presumably healthy patients) compared to fee-for-service physicians. However, we do not have evidence that physicians in capitation-based models are reducing the care they provide to sick and high cost patients. These findings suggest there is a relationship between payment type and risk-selection, particularly for low-cost and healthy patients.

KEYWORDS:

Canada; Case mix; Ontario; Payment incentives; Physician behavior; Primary care; Relative distribution

PMID:
25461858
DOI:
10.1016/j.socscimed.2014.11.001
[Indexed for MEDLINE]

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