Interprofessional team-based primary care practice and preventive cancer screening: evidence from Family Health Teams in Ontario, Canada.

Health care reforms introduced interprofessional team-based primary care to optimize access to health care and preventive services. In this context, preventive cancer screening represents an important measure as it is essential for the early detection of cancer and treatment. We investigated the effects of Family Health Teams (FHTs), an interprofessional team-based primary care practice setting, on cancer screening rates in Ontario, Canada.

Does financial incentive for diabetes management in the primary care setting reduce avoidable hospitalizations and mortality in high-income countries? A systematic review.

Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science.

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis.

Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma).

Primary care services and emergency department visits in blended fee-for-service and blended capitation models: evidence from Ontario, Canada.

Introduction: It is well-known that the way physicians are remunerated can affect delivery of health care services to the population. Fee-for-service (FFS) generally leads to oversupply of services, while capitation leads to undersupply of services. However, little evidence exists on the link between remuneration and emergency department (ED) visits.

Quality of Diabetes Care in Blended Fee-for-Service and Blended Capitation Payment Systems.

Objectives: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.

Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models.

Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations.

Stirring the pot: Switching from blended fee-for-service to blended capitation models of physician remuneration.

In Canada's most populous province, Ontario, family physicians may choose between the blended fee-for-service (Family Health Group [FHG]) and blended capitation (Family Health Organization [FHO] payment models). Both models incentivize physicians to provide after-hours (AH) and comprehensive care, but FHO physicians receive a capitation payment per enrolled patient adjusted for age and sex, plus a reduced fee-for-service while FHG physicians are paid by fee-for-service. We develop a theoretical model of physician labor supply with multitasking to predict their behavior under FHG and FHO, and estimable equations are derived to test the predictions empirically.

The impact of the diabetes management incentive on diabetes-related services: evidence from Ontario, Canada.

Financial incentives have been introduced in several countries to improve diabetes management. In Ontario, the most populous province in Canada, a Diabetes Management Incentive (DMI) was introduced to family physicians practicing in patient enrollment models in 2006. This paper examines the impact of the DMI on diabetes-related services provided to individuals with diabetes in Ontario.

Production of physician services under fee-for-service and blended fee-for-service: Evidence from Ontario, Canada.

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services.

Unmet health care and health care utilization.

The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014).

Social capital and having a regular family doctor: Evidence from longitudinal data.

Access to a regular source of health-care is problematic for some, irrespective of whether the regime is publicly or privately funded. Yet, evidence shows that access to a regular family doctor improves health outcomes. We are the first to examine the impact of social capital (e.

Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit.

Background: ICU care is costly, and there is a large variation in cost among patients.

Methods: This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population.

Family physician remuneration schemes and specialist referrals: Quasi-experimental evidence from Ontario, Canada.

Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed.

Revisiting the relationship between wages and sleep duration: The role of insomnia.

This paper uses the 2005 and 2010 Canadian General Social Surveys (Time Use) to investigate the effect of wages on the sleep duration of individuals in the labour force. The endogeneity of wages is taken into account with an instrumental variables approach; we find that the wage rate affects sleeping time in general, corroborating Biddle and Hamermesh's (1990) main conclusion. A ten percent increase in the wage rate leads to an 11-12min decrease in sleep per week.

The Effect of Leisure-Time Physical Activity on Obesity, Diabetes, High BP and Heart Disease Among Canadians: Evidence from 2000/2001 to 2005/2006.

Although studies have looked at the effect of physical activity on obesity and other health outcomes, the causal nature of this relationship remains unclear. We fill this gap by investigating the impact of leisure-time physical activity (LTPA) and work-related physical activity (WRPA) on obesity and chronic conditions in Canadians aged 18-75 using instrumental variable and recursive bivariate probit approaches. Average local temperatures surrounding the respondents' interview month are used as a novel instrument to help identify the causal relationship between LTPA and health outcomes.

Social networks and the probability of having a regular family doctor.

Social supports have been shown to affect health in a variety of ways. This paper explores a hitherto ignored avenue linking social supports to health, namely through their influence on having a regular family doctor. We examine the role played by social supports in helping to explain why a significant portion of the Canadian population does not have a regular family doctor even though primary care is fully covered by the public insurer and when having a regular physician is associated with better care and with access to specialists.

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

Objective: To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics.

Design: Cross-sectional survey.

Setting: One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres).

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

Background: As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada.

Methods: Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models.

Practice size, financial sharing and quality of care.

Background: Although we are observing a general move towards larger primary care practices, surprisingly little is known about the influence of key components of practice organization on primary care. We aimed to determine the relationships between practice size, and revenue sharing agreements, and quality of care.

Methods: As part of a large cross sectional study, group practices were randomly selected from different primary care service delivery models in Ontario.

Canadian family physicians' decision to collaborate: age, period and cohort effects.

One of the core primary care reform initiatives seen across provinces in Canada is the introduction of inter-professional primary healthcare teams in which family physicians are encouraged to collaborate with other health professionals. Although a higher proportion of physicians are collaborating with various health professionals now compared to the previous decade, a substantial number of physicians still do not work in a collaborative setting. The objective of this paper is to examine the age, period and cohort effects of Canadian family physicians' decisions to collaborate with seven types of health professionals: specialists, nurse practitioners, nurses, dieticians, physiotherapists, psychologists and occupational therapists.

Estimating patient demographic profiles from practice location.

Objective: To test the accuracy of imputing a practice population's average socioeconomic characteristics (such as average education levels and average income) using census data centred on the location of the practice.

Design: Comparison of census data with survey data collected in primary care offices.

Setting: Ontario.

Comparative efficiency assessment of primary care service delivery models using data envelopment analysis.

This paper compares the relative productive efficiencies of four models of primary care service delivery using the data envelopment analysis method on 130 primary care practices in Ontario, Canada. A quality-controlled measure of output and two input scenarios are employed: one with full-time-equivalent labour inputs and the other with total expenditures. Regression analysis controls for the mix of patients in the practice population.

The role of supplemental coverage in a universal health insurance system: Some Canadian evidence.

Objective: To examine the effect of supplemental health insurance for prescription drug coverage on health care utilization as measured by the number of visits to physicians in a setting with incomplete public insurance coverage.

Methods: A latent-class modeling approach is used to capture the presence of latent heterogeneity in the utilization of physician services. The insurance variable is grouped into three different types, depending upon how it is provided - by government, employers, or private companies.

Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity.

Objectives: To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care.

Methods: Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously.

An evaluation of gender equity in different models of primary care practices in Ontario.

Background: The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.

Methods: This cross sectional study of primary care practices uses data collected in 2005-2006.