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Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada

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  • Laberge, Maude
  • Wodchis, Walter P.
  • Barnsley, Jan
  • Laporte, Audrey

Abstract

The study analyzes the relationship between the risk of a hospitalization for an ambulatory care sensitive condition (ACSC), and the primary care payment and the organizational model used by the patient (fee-for-service, enhanced fee-for-service, blended capitation, blended capitation with interdisciplinary teams). The study used linked patient-level health administrative databases and census data housed at the Institute for Clinical Evaluative Sciences in Ontario. Since the province provides universal health care, the data capture all patients in Ontario, Canada's most populous province, with about 13 million inhabitants. All Ontario patients diagnosed with an ACSC prior to April 1, 2012, who had at least one visit with a physician between April 1, 2012, and March 31, 2013, were included in the study (n = 1,710,310). Each patient was assigned to the primary care model of his/her physician. The different models were categorized as Fee-for-Service (FFS), enhanced-FFS, blended capitation, and interdisciplinary team. A logistic regression was used to model the risk of having an ACSC hospitalization during the one-year observation period. Adjustments were made for patient characteristics (age, sex, health status, and socio-economic status) and for the geographic location of the practice. Using patients belonging to FFS models as the reference group, the risk of an ACSC hospitalization was higher for patients belonging to the blended-capitation model using interdisciplinary teams (Adjusted Odds Ratio [AOR] = 1.06, 95% confidence interval [CI] = 1.00–1.12) and lower for enhanced-FFS (AOR = 0.78, CI = 0.74–0.82) and blended capitation patients (AOR = 0.91, CI = 0.86–0.96). Using patients with hypertension as the reference group, the odds of an ACSC hospitalization were much higher for patients with any other ACSC and increased with patients' morbidity. The risk was lower for patients of higher socio-economic status (AOR = 0.63, CI = 0.60–0.67) in the highest neighborhood income quintile.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:socmed:v:181:y:2017:i:c:p:24-33
    DOI: 10.1016/j.socscimed.2017.03.040
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    References listed on IDEAS

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    1. 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.
    2. Jasmin Kantarevic & Boris Kralj, 2013. "Link Between Pay For Performance Incentives And Physician Payment Mechanisms: Evidence From The Diabetes Management Incentive In Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1417-1439, December.
    3. 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.
    4. Bich Tran & Michael O Falster & Kirsty Douglas & Fiona Blyth & Louisa R Jorm, 2014. "Health Behaviours and Potentially Preventable Hospitalisation: A Prospective Study of Older Australian Adults," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    5. repec:zbw:rwirep:0543 is not listed on IDEAS
    6. Jeannette Brosig‐Koch & Heike Hennig‐Schmidt & Nadja Kairies‐Schwarz & Daniel Wiesen, 2017. "The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 243-262, February.
    7. Leonie Sundmacher & Thomas Kopetsch, 2015. "The impact of office-based care on hospitalizations for ambulatory care sensitive conditions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 365-375, May.
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    Cited by:

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    2. Natalia Nunes Ferreira‐Batista & Adriano Dutra Teixeira & Maria Dolores Montoya Diaz & Fernando Antonio Slaibe Postali & Rodrigo Moreno‐Serra & James Love‐Koh, 2023. "Is primary health care worth it in the long run? Evidence from Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1504-1524, July.
    3. Ting Chen & Jay Pan, 2022. "The Effect of Spatial Access to Primary Care on Potentially Avoidable Hospitalizations of the Elderly: Evidence from Chishui City, China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 645-665, April.
    4. Lauren E Wallar & Laura C Rosella, 2020. "Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study," PLOS ONE, Public Library of Science, vol. 15(3), pages 1-21, March.
    5. Laberge, Maude & Gaudreault, Myriam, 2019. "Promoting access to family medicine in Québec, Canada: Analysis of bill 20, enacted in November 2015," Health Policy, Elsevier, vol. 123(10), pages 901-905.
    6. Spycher, Jacques & Morisod, Kevin & Moschetti, Karine & Le Pogam, Marie-Annick & Peytremann-Bridevaux, Isabelle & Bodenmann, Patrick & Cookson, Richard & Rodwin, Victor & Marti, Joachim, 2024. "Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis," Health Policy, Elsevier, vol. 139(C).
    7. Duminy, Lize & Ress, Vanessa & Wild, Eva-Maria, 2022. "Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review," Health Policy, Elsevier, vol. 126(12), pages 1206-1225.

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