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The impact of team-based primary care on health care services utilization and costs: Quebec’s family medicine groups

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  • Strumpf, Erin
  • Ammi, Mehdi
  • Diop, Mamadou
  • Fiset-Laniel, Julie
  • Tousignant, Pierre

Abstract

We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec’s Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients’ health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation.

Suggested Citation

  • Strumpf, Erin & Ammi, Mehdi & Diop, Mamadou & Fiset-Laniel, Julie & Tousignant, Pierre, 2017. "The impact of team-based primary care on health care services utilization and costs: Quebec’s family medicine groups," Journal of Health Economics, Elsevier, vol. 55(C), pages 76-94.
  • Handle: RePEc:eee:jhecon:v:55:y:2017:i:c:p:76-94
    DOI: 10.1016/j.jhealeco.2017.06.009
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    Cited by:

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    2. Yiwei Chen & Hui Ding & Min Yu & Jieming Zhong & Ruying Hu & Xiangyu Chen & Chunmei Wang & Kaixu Xie & Karen Eggleston, 2019. "The Effects of Primary Care Chronic-Disease Management in Rural China," NBER Working Papers 26100, National Bureau of Economic Research, Inc.
    3. Somé, N.H. & Devlin, R.A. & Mehta, N. & Zaric, G.S. & Sarma, S., 2020. "Team-based primary care practice and physician's services: Evidence from Family Health Teams in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 264(C).
    4. Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2019. "Coopérer plus pour travailler plus : évaluation de l’expérimentation d’infirmière de pratique avancée Asalée sur l’activité du médecin généraliste," Erudite Working Paper 2019-13, Erudite.
    5. Haj-Ali, Wissam & Moineddin, Rahim & Hutchison, Brian & Wodchis, Walter P. & Glazier, Richard H., 2020. "Physician group, physician and patient characteristics associated with joining interprofessional team-based primary care in Ontario, Canada," Health Policy, Elsevier, vol. 124(7), pages 743-750.

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    More about this item

    Keywords

    Primary care; Health care utilization; Health care costs; Propensity score matching; Inverse probability of treatment weighting; Difference-in-differences; Quebec;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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