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Quality and quantity in primary care mixed‐payment models: evidence from family health organizations in Ontario

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  • Boris Kralj
  • Jasmin Kantarevic

Abstract

We study the impact of a mixed capitation model (the Family Health Organization, FHO) on quality and quantity outcomes among primary care physicians in Ontario. Using a panel of administrative data covering one year before and two years after the FHO model was introduced, we find that physicians in the FHO model provide about 6% to 7% fewer services and visits per day, but are between 7% and 11% more likely to achieve preventive care quality targets. These results suggest that the mixed capitation model with contractible quality indicators may be welfare improving relative to the FFS model. On étudie l’impact d’un modèle mixte de capitation (les organismes de santé familiale de l’Ontario) sur les résultats en termes de qualité et quantité du travail des médecins de première ligne en Ontario. A l’aide d’un panel de données administratives couvrant la période allant d’un an avant la mise en place de l’arrangement à deux ans après, on montre que les médecins opérant dans ce cadre ont fourni de 6%à 7% de moins de services et de visites par jour, mais sont entre 7% et 11% plus susceptibles d’avoir réussi à atteindre les cibles de qualité de soins préventifs. Les résultats suggèrent que ce modèle avec des indicateurs contractuels pour assurer la qualité peut améliorer le niveau de bien‐être par rapport aux résultats du modèle d’honoraires pour les services.

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  • Boris Kralj & Jasmin Kantarevic, 2013. "Quality and quantity in primary care mixed‐payment models: evidence from family health organizations in Ontario," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 46(1), pages 208-238, February.
  • Handle: RePEc:wly:canjec:v:46:y:2013:i:1:p:208-238
    DOI: 10.1111/caje.12003
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    Cited by:

    1. 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.
    2. Logan McLeod, Jeffrey A. Johnson, 2014. "Changing the Schedule of Medical Benefits and the Effect on Primary Care Physician Billing: Quasi-Experimental Evidence from Alberta," LCERPA Working Papers 0077, Laurier Centre for Economic Research and Policy Analysis, revised 28 Aug 2014.
    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. 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.
    5. Sterre S. Bour & Lena H. A. Raaijmakers & Erik W. M. A. Bischoff & Lucas M. A. Goossens & Maureen P. M. H. Rutten-van Mölken, 2023. "How Can a Bundled Payment Model Incentivize the Transition from Single-Disease Management to Person-Centred and Integrated Care for Chronic Diseases in the Netherlands?," IJERPH, MDPI, vol. 20(5), pages 1-20, February.
    6. Vu, Thyna & Anderson, Kelly K. & Devlin, Rose Anne & Somé, Nibene H. & Sarma, Sisira, 2021. "Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models," Social Science & Medicine, Elsevier, vol. 268(C).
    7. 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.
    8. Jeffrey Smith & Arthur Sweetman, 2016. "Viewpoint: Estimating the causal effects of policies and programs," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 49(3), pages 871-905, August.
    9. repec:zbw:rwirep:0543 is not listed on IDEAS
    10. Jeannette Brosig-Koch & Heike Hennig-Schmidt & Nadja Kairies-Schwarz & Daniel Wiesen, 2015. "The Effects of Introducing Mixed Payment Systems for Physicians – Experimental Evidence," Ruhr Economic Papers 0543, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    11. Christian Volmar Skovsgaard & Troels Kristensen & Ryan Pulleyblank & Kim Rose Olsen, 2023. "Increasing capitation in mixed remuneration schemes: Effects on service provision and process quality of care," Health Economics, John Wiley & Sons, Ltd., vol. 32(11), pages 2477-2498, November.

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