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

Published: November 5, 2014
Category: Bibliography > Papers
Authors: Barnsley J, Deber RB, Glazier RH, Laporte A, Rudoler D
Countries: Canada
Language: null
Types: Finance/Budgeting, Population Health
Settings: Hospital, PCP

Soc Sci Med 124:18-28.

University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

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.

PMID: 25461858

Canada,Capitation,Risk-bearing Entities,Morbidity Pattern,Cross-Sectional Studies,Fees and Charges,Insurance, Health,Reimbursement,Ontario,Reimbursement,Incentive


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