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Evaluation of the equity of age–sex adjusted primary care capitation payments in Ontario, Canada

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  • Sibley, Lyn M.
  • Glazier, Richard H.

Abstract

Several innovative primary care models have recently been introduced in Ontario, Canada. Two of these models are funded primarily through age–sex based capitation. There is concern that adjusting capitation rates for age and sex alone does not take into account the increased morbidity burden and health care needs that are associated with lower socioeconomic status. This study assesses the extent to which the current age–sex capitation rates in Ontario reflect health care needs of patients across socioeconomic status by comparing Ontario's age–sex adjusted capitation remuneration rate index with relative expected health care resource use by socioeconomic status (SES).

Suggested Citation

  • Sibley, Lyn M. & Glazier, Richard H., 2012. "Evaluation of the equity of age–sex adjusted primary care capitation payments in Ontario, Canada," Health Policy, Elsevier, vol. 104(2), pages 186-192.
    • Handle: RePEc:eee:hepoli:v:104:y:2012:i:2:p:186-192
    DOI: 10.1016/j.healthpol.2011.10.008
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    References listed on IDEAS

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    1. Reid, R.J. & MacWilliam, l. & Verhulst, L. & Roos, N. & Atkinson, M., 2001. "Performance of the ACG Case-Mix System in Two Canadian Provinces," Centre for Health Services and Policy Research 2001:1r, University of British Columbia - Centre for Health Services and Policy Research..
    2. Humphries, Karin H. & van Doorslaer, Eddy, 2000. "Income-related health inequality in Canada," Social Science & Medicine, Elsevier, vol. 50(5), pages 663-671, March.
    3. van de Ven, Wynand P.M.M. & Beck, Konstantin & Van de Voorde, Carine & Wasem, Jurgen & Zmora, Irit, 2007. "Risk adjustment and risk selection in Europe: 6 years later," Health Policy, Elsevier, vol. 83(2-3), pages 162-179, October.
    4. Sisira Sarma & Rose Anne Devlin & William Hogg, 2010. "Physician's production of primary care in Ontario, Canada," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 14-30, January.
    5. Reid, R. & MacWilliam, L. & Roos, N.P. & Bogdanovich, B. & Black, C., 1999. "Measuring Morbidity in Populations: Performance of the John Hopkins Adjusted Clinical Group (ACG) Case-Mix Adjustment System in Manitoba," Centre for Health Services and Policy Research 99:9, University of British Columbia - Centre for Health Services and Policy Research..
    6. Frank T. Denton & Amiram Gafni & Byron G. Spencer, 2005. "Users and Suppliers of Physician Services: A Tale of Two Populations," Quantitative Studies in Economics and Population Research Reports 399, McMaster University.
    7. repec:dau:papers:123456789/10510 is not listed on IDEAS
    8. van de Ven, Wynand P. M. M. & Beck, Konstantin & Buchner, Florian & Chernichovsky, Dov & Gardiol, Lucien & Holly, Alberto & Lamers, Leida M. & Schokkaert, Erik & Shmueli, Amir & Spycher, Stephan & Van, 2003. "Risk adjustment and risk selection on the sickness fund insurance market in five European countries," Health Policy, Elsevier, vol. 65(1), pages 75-98, July.
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    Cited by:

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    2. 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.
    3. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.
    4. 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.
    5. Troels Kristensen & Kim Olsen & Henrik Schroll & Janus Thomsen & Anders Halling, 2014. "Association between fee-for-service expenditures and morbidity burden in primary care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(6), pages 599-610, July.
    6. Somi Shin & Christoph Schumacher & Eberhard Feess, 2017. "Do Capitation‐based Reimbursement Systems Underfund Tertiary Healthcare Providers? Evidence from New Zealand," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 81-102, December.
    7. Jong-Yi Wang & Chiu-Shong Liu & Chi-Hsuan Lung & Ya-Tun Yang & Ming-Hung Lin, 2017. "Investigating spousal concordance of diabetes through statistical analysis and data mining," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-16, August.

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