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

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  • Rudoler, David
  • Laporte, Audrey
  • Barnsley, Janet
  • Glazier, Richard H.
  • Deber, Raisa B.

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.

Suggested Citation

  • Rudoler, David & Laporte, Audrey & Barnsley, Janet & Glazier, Richard H. & Deber, Raisa B., 2015. "Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada," Social Science & Medicine, Elsevier, vol. 124(C), pages 18-28.
    • Handle: RePEc:eee:socmed:v:124:y:2015:i:c:p:18-28
    DOI: 10.1016/j.socscimed.2014.11.001
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    1. Marchildon, Gregory P. & Hutchison, Brian, 2016. "Primary care in Ontario, Canada: New proposals after 15 years of reform," Health Policy, Elsevier, vol. 120(7), pages 732-738.
    2. Jasmin Kantarevic & Boris Kralj, 2016. "Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 25(10), pages 1326-1340, October.
    3. David Rudoler & Raisa Deber & Janet Barnsley & Richard H. Glazier & Adrian Rohit Dass & Audrey Laporte, 2015. "Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1229-1242, September.
    4. Laberge, Maude & Wodchis, Walter P. & Barnsley, Jan & Laporte, Audrey, 2017. "Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 181(C), pages 24-33.
    5. Thomas Christopher Lange & Travis Carpenter & Jennifer Zwicker, 2020. "Primary Care Physician Compensation Reform: A Path for Implementation," SPP Research Papers, The School of Public Policy, University of Calgary, vol. 13(4), April.
    6. Rudoler, David & Peckham, Allie & Grudniewicz, Agnes & Marchildon, Greg, 2019. "Coordinating primary care services: A case of policy layering," Health Policy, Elsevier, vol. 123(2), pages 215-221.

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