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Health Policy. 2018 Feb;122(2):157-164. doi: 10.1016/j.healthpol.2017.11.001. Epub 2017 Nov 10.

Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis.

Author information

1
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 10502, 8888 University Drive, Burnaby, BC V5A 1S6, Canada. Electronic address: ruth_lavergne@sfu.ca.
2
Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
3
Department of Family Medicine, University of Alberta, 6-60 University Terrace, Edmonton, AB T6G 2T4, Canada.
4
Department of Economics, and Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.

Abstract

We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive dispensing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD.

KEYWORDS:

Administrative data uses; Chronic disease; Incentives in health care; Primary care; Time series analysis

PMID:
29153847
DOI:
10.1016/j.healthpol.2017.11.001
[Indexed for MEDLINE]
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