Do Incentive Payments Reward The Wrong Providers? A Study Of Primary Care Reform In Ontario, Canada

Published: April 13, 2019
Category: Bibliography
Authors: Alex Kopp, Eliot Frymire, Kamila Premji, Michael E. Green, Richard H. Glazier, Tara Kiran, William Hogg
Countries: Canada
Language: English
Types: Finance/Budgeting, Performance Analysis
Settings: Government, PCP


Primary care payment reform in the US and elsewhere usually involves capitation, often combined with bonuses and incentives. In capitation systems, providing care within the practice group is needed to contain costs and ensure continuity of care, yet this is challenging in settings that allow patient choice in access to services. We used linked population-based administrative databases in Ontario, Canada, to examine a substantial payment called the “access bonus” designed to incentivize primary care access and to minimize primary care visits outside of capitation practices. We found that the access bonus flowed disproportionately to physicians outside large cities and to those whose patients made fewer primary care visits, received less after-hours care, made more emergency department visits, and had higher adjusted ambulatory costs. Our findings indicate a lack of alignment between these payments and their intended purpose. Financial incentives should be prospectively evaluated and frequently revisited to ensure relevance, alignment with system goals, efficiency, and equity.


access to care,primary care,payment,emergency departments,capitation,physician payment,fee-for-service,physicians,access and use

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