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Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models

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  • David Rudoler
  • Raisa Deber
  • Janet Barnsley
  • Richard H. Glazier
  • Adrian Rohit Dass
  • Audrey Laporte

Abstract

To determine the factors associated with primary care physician self‐selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self‐selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation‐based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects. Copyright © 2015 John Wiley & Sons, Ltd.

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  • 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.
  • Handle: RePEc:wly:hlthec:v:24:y:2015:i:9:p:1229-1242
    DOI: 10.1002/hec.3221
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    1. Nibene H. Somé & Rose Anne Devlin & Nirav Mehta & Gregory S. Zaric & Sisira Sarma, 2020. "Stirring the pot: Switching from blended fee‐for‐service to blended capitation models of physician remuneration," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1435-1455, November.
    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. Kurt R. Brekke & Tor Helge Holmås & Karin Monstad & Odd Rune Straume, 2020. "How Does The Type of Remuneration Affect Physician Behavior?," American Journal of Health Economics, University of Chicago Press, vol. 6(1), pages 104-138.
    4. Brosig-Koch, Jeannette & Kairies-Schwarz, Nadja & Kokot, Johanna, 2014. "Sorting into Physician Payment Schemes – A Laboratory Experiment," Ruhr Economic Papers 529, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    5. Jeannette Brosig-Koch & Nadja Kairies-Schwarz & Johanna Kokot, 2014. "Sorting into Physician Payment Schemes – A Laboratory Experiment," Ruhr Economic Papers 0529, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    6. 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.
    7. 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.
    8. 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.
    9. repec:zbw:rwirep:0529 is not listed on IDEAS
    10. Zhang, Xue & Sweetman, Arthur, 2018. "Blended capitation and incentives: Fee codes inside and outside the capitated basket," Journal of Health Economics, Elsevier, vol. 60(C), pages 16-29.
    11. 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.
    12. Peckham, Allie & Morton-Chang, Frances & Williams, A. Paul & Miller, Fiona A., 2018. "Rebalancing health systems toward community-based care: The role of subsectoral politics," Health Policy, Elsevier, vol. 122(11), pages 1260-1265.
    13. Jeannette Brosig‐Koch & Nadja Kairies‐Schwarz & Johanna Kokot, 2017. "Sorting into payment schemes and medical treatment: A laboratory experiment," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 52-65, December.

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    More about this item

    JEL classification:

    • D22 - Microeconomics - - Production and Organizations - - - Firm Behavior: Empirical Analysis
    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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