Grant: Travel Awards - Institute Community Support

Ontario experimented with several compensation schemes for primary care physicians (PCPs). However, incentives in different schemes may produce both intended and unintended consequences. This study presents a description of Ontario's payment schemes, the incentives embedded in them, and the impact these incentives might have on the practice of primary care. We reviewed the physician services agreements for Ontario's most prominent payment schemes to determine the incentives they contain. These schemes included: Family Health Groups, the Comprehensive Care Model, Family Health Networks, Family Health Organizations, and the Blended Salary Model. Data on the number of patients/physicians enrolled in each scheme was used to determine how enrolment distributions have changed over time. Relevant economic literature was adapted to Ontario to explain the theoretical impact of the new payment schemes on PCP behaviour. The new payment schemes in Ontario move away from traditional fee-for-service payment to prospective forms of remuneration. Economic theory suggests that the incentives embedded in the new payment schemes encourage PCPs to reduce service intensity for more complex patients, and/or avoid highly complex patients altogether. As of 2011, 7674 (60%) of Ontario PCPs switched into one of the new payment schemes, and had a rostered patient population of approximately 9.5 million (70% of Ontario's population). This is important from a cost perspective as a majority of primary care services in Ontario is now delivered through one of these models. Since the implementation of these payment schemes, the cost of primary care services has increased considerably. One possible explanation for a cost increase is that a high proportion of PCPs have switched into new payment schemes that inadvertently overpay, particularly if PCPs are avoiding high cost/complexity patients. We plan to use administrative data to determine the extent to which this is occurring in practice.