Project 464725

Stronger primary health care systems are associated with better health outcomes compared to those with weaker systems. Reforms introduced worldwide to address better access to primary care, preventive care and the management of chronic diseases. Common across these reform strategies is the move away from pure fee-for-service (FFS) remuneration towards alternative approaches: blended FFS (FFS plus incentives), blended capitation (fixed rate per patient plus incentives) or blended salary (fixed salary plus incentives) remuneration as well as interprofessional teams within blended remuneration models. Ontario is the only jurisdiction in the world with the full gamut of these models, and hence presents an ideal environment in which to evaluate outcomes of alternative primary care remuneration models. Our team has undertaken innovative quasi-experimental studies evaluating the change in physician remuneration from blended FFS to blended capitation on healthcare services. We propose to build on this foundational work to undertake extensive evaluation of physician behaviour in the areas of access to primary care and mental health services, preventive care (cancer screening and immunization), chronic disease management (diabetes, congestive heart failure and chronic kidney disease), and patient outcomes (preventable emergency department visits, avoidable hospitalizations and premature mortality) in alternative remuneration models. To investigate these issues, we will use longitudinal health administrative databases from Ontario spanning April 1st 2005 to March 31st 2023 and employ state-of-the-art quasi-experimental methods. Our research will provide new knowledge on the strengths and weaknesses of alternative primary care remuneration models to improve access to primary care and patient outcomes, and guide evidence-based health policy decisions in Ontario, other Canadian jurisdictions and abroad.