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

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Tytuł:: Stirring the pot: Switching from blended fee-for-service to blended capitation models of physician remuneration.
Autorzy:: Somé NH; Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada.; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Devlin RA; Department of Economics, University of Ottawa, Ottawa, Ontario, Canada.
Mehta N; Department of Economics, University of Western Ontario, London, Ontario, Canada.
Zaric GS; Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada.; Ivey School of Business, University of Western Ontario, London, Ontario, Canada.
Sarma S; Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada.; ICES, Toronto, Ontario, Canada.
Źródło:: Health economics [Health Econ] 2020 Nov; Vol. 29 (11), pp. 1435-1455. Date of Electronic Publication: 2020 Aug 19.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Original Publication: Chichester ; New York : Wiley, c1992-
MeSH Terms:: Capitation Fee*
Remuneration*
Fee-for-Service Plans ; Humans ; Physicians, Family ; Salaries and Fringe Benefits
References:: Allard, M., Jelovac, I., & Léger, P. T. (2014). Payment mechanism and GP self-selection: Capitation versus fee for service. International Journal of Health Care Finance and Economics, 14, 143-160. https://doi.org/10.1007/s10754-014-9143-z.
Allard, M., Jelovac, I., & Léger, P. T. (2011). Treatment and referral decisions under different physician payment mechanisms. Journal of Health Economics, 30, 880-893. https://doi.org/10.1016/j.jhealeco.2011.05.016.
Arrow, K. J., Chenery, H. B., Minhas, B. S., & Solow, R. M. (1961). Capital-labor substitution and economic efficiency. The Review of Economics and Statistics, 43, 225-250. https://doi.org/10.2307/1927286.
Balazsi, L., Matyas, L., & Wansbeek, T. (2018). The estimation of multidimensional fixed effects panel data models. Econometric Reviews, 37, 212-227. https://doi.org/10.1080/07474938.2015.1032164.
Barros, P. P. (2003). Cream-skimming, incentives for efficiency and payment system. Journal of Health Economics, 22, 419-443. https://doi.org/10.1016/S0167-6296(02)00119-4.
Blomqvist, A. (1997). Monopolistic competition and supply-side cost sharing in the physician services market (Working Paper No. 9705). London, ON: Department of Economics, University of Western Ontario.
Campbell, S., Reeves, D., Kontopantelis, E., Middleton, E., Sibbald, B., & Roland, M. (2007). Quality of primary care in England with the introduction of pay for performance. New England Journal of Medicine, 357, 181-190. https://doi.org/10.1056/nejmsr065990.
Chami, N., & Sweetman, A. (2019). Payment models in primary health care: A driver of the quantity and quality of medical laboratory utilization. Health Economics, 28, 1166-1178. https://doi.org/10.1002/hec.3927.
Chandra, A., Cutler, D., & Song, Z. (2011). Who ordered that? The economics of treatment choices in medical care. Handbook of Health Economics, 397-432. https://doi.org/10.1016/B978-0-444-53592-4.00006-2.
Clemens, J., & Gottlieb, J. D. (2014). Do physicians' financial incentives affect medical treatment and patient health? The American Economic Review, 104, 1320-1349. https://doi.org/10.1257/aer.104.4.1320.
Correia, S. (2017). Reghdfe: Stata module for linear and instrumental-variable/GMM regression absorbing multiple levels of fixed effects, Statistical Software Components s457874. Boston, MA: Boston College.
Devlin, R. A., & Sarma, S. (2008). Do physician remuneration schemes matter? The case of Canadian family physicians. Journal of Health Economics, 27, 1168-1181. https://doi.org/10.1016/j.jhealeco.2008.05.006.
Devlin, R. A., Kpelitse, K. A., Li, L., Mehta, N., & Sarma, S. (2020). After-hours incentives and emergency department visits: Evidence from Canada. Canadian Public Policy, 46(20), 253-263. https://doi.org/10.3138/cpp.2019-046.
Di Guida, S., Gyrd-Hansen, D., & Oxholm, A. S. (2019). Testing the myth of fee-for-service and overprovision in health care. Health Economics, 28, 717-722. https://doi.org/10.1002/hec.3875.
Dumont, E., Fortin, B., Jacquemet, N., & Shearer, B. (2008). Physicians' multitasking and incentives: Empirical evidence from a natural experiment. Journal of Health Economics, 27, 1436-1450. https://doi.org/10.1016/j.jhealeco.2008.07.010.
Ellis, R. P. (1998). Creaming, skimping and dumping: Provider competition on the intensive and extensive margins. Journal of Health Economics, 17, 537-555. https://doi.org/10.1016/S0167-6296(97)00042-8.
Ellis, R. P., & McGuire, T. G. (1993). Supply-side and demand-side cost sharing in health care. The Journal of Economic Perspectives, 7, 135-151. https://doi.org/10.1257/jep.7.4.135.
Giles, D. E. (2011). Interpreting dummy variables in semi-logarithmic regression models: Exact distributional results (Econometrics Working Paper No. EWP1101) (pp. 1-24). British Columbia, VIC: Department of Economics, University of Victoria.
Glazier, R., Moineddin, R., Agha, M. M., Zagorski, B., Hall, R., & Ontario, I. (2008). The impact of not having a primary care physician among people with chronic conditions. Toronto, ON: Institute for Clinical Evaluative Sciences.
Gneezy, U., Meier, S., & Rey-Biel, P. (2011). When and why incentives (don't) work to modify behavior. The Journal of Economic Perspectives, 25, 191-210. https://doi.org/10.1257/jep.25.4.191.
Grytten, J., & Sørensen, R. (2001). Type of contract and supplier-induced demand for primary physicians in Norway. Journal of Health Economics, 20, 379-393. https://doi.org/10.1016/S0167-6296(00)00087-4.
Guimarães, P., & Portugal, P. (2010). A simple feasible procedure to fit models with high-dimensional fixed effects. Stata Journal.
Hainmueller, J. (2012). Entropy balancing for causal effects: A multivariate reweighting method to produce balanced samples in observational studies. Political Analysis, 20, 25-46. https://doi.org/10.1093/pan/mpr025.
Hausman, D., & Le Grand, J. (1999). Incentives and health policy: primary and secondary care in the British National Health Service. Social Science & Medicine, 49, 1299-1307. https://doi.org/10.1016/S0277-9536(99)00204-X.
Imai, K., & Ratkovic, M. (2014). Covariate balancing propensity score. Journal of the Royal Statistical Society: Series B Statistical Methodology, 76, 243-263. https://doi.org/10.1111/rssb.12027.
Iversen, T. (2016). Primary care: Effectiveness and costs. In R. M. Scheffler (Ed.), World Scientific Handbook of Global Health Economics and Public Policy, World Scientific Series in Global Health Economics and Public Policy (pp. 231-268). Singapore: World Scientific. https://doi.org/10.1142/9789813140530_0005.
Jan van Garderen, K., & Shah, C. (2002). Exact interpretation of dummy variables in semilogarithmic equations. The Econometrics Journal, 5, 149-159. https://doi.org/10.1111/1368-423x.00078.
Kang, J. D. Y., & Schafer, J. L. (2007). Demystifying double robustness: A comparison of alternative strategies for estimating a population mean from incomplete data. Statistical Science, 22, 523-539. https://doi.org/10.1214/07-STS227.
Kantarevic, J., Kralj, B., & Weinkauf, D. (2008). Income effects and physician labour supply: Evidence from the threshold system in Ontario. Canadian Journal of Economics, 41, 1262-1284. https://doi.org/10.1111/j.1540-5982.2008.00503.x.
Kralj, B., & Kantarevic, J. (2013). Quality and quantity in primary care mixed-payment models: Evidence from family health organizations in Ontario. Canadian Journal of Economics, 46, 208-238. https://doi.org/10.1111/caje.12003.
Lechner, M. (2011). The Estimation of causal effects by difference-in-difference methods estimation of spatial panels. Foundations and Trends® in Econometrics, 4, 165-224. https://doi.org/10.1561/0800000014.
Lee, W. S. (2013). Propensity score matching and variations on the balancing test. Empirical Economics, 44, 47-80. https://doi.org/10.1007/s00181-011-0481-0.
Li, J., Hurley, J., Decicca, P., & Buckley, G. (2014). Physician response to pay-for-performance: Evidence from a natural experiment. Health Economics, 23, 962-978. https://doi.org/10.1002/hec.2971.
Ma, C. A. (1994). Health care payment systems: Cost and quality incentives. Journal of Economics and Management Strategy, 3, 93-112. https://doi.org/10.1111/j.1430-9134.1994.00093.x.
Ma, C. T. O. A., & Mcguire, T. G. (1997). Optimal health insurance and provider payment. The American Economic Review, 87, 685-704.
Marchildon, G. P., & Hutchison, B. (2016). Primary care in Ontario, Canada: New proposals after 15 years of reform. Health Policy, 120, 732-738. https://doi.org/10.1016/j.healthpol.2016.04.010.
Matsaganis, M., & Glennerster, H. (1994). The threat of “cream skimming” in the post-reform NHS. Journal of Health Economics, 13, 31-60. https://doi.org/10.1016/0167-6296(94)90003-5.
Mattison, C. A., & Wilson, M. G. (2017). Rapid synthesis: Examining the effects of value-based physician payment models, McMaster Health Forum. Hamilton, ON: McMaster Health Forum. https://www.mcmasterforum.org/docs/default-source/product-documents/rapid-responses/examining-the-effects-of-value-based-physician-payment-models.pdf?sfvrsn=2.
McGuire, T. G. (2000). Chapter 9 Physician agency. Handbook of Health Economics, 461-536. https://doi.org/10.1016/S1574-0064(00)80168-7.
McGuire, T. G., & Pauly, M. V. (1991). Physician response to fee changes with multiple payers. Journal of Health Economics, 10, 385-410. https://doi.org/10.1016/0167-6296(91)90022-F.
Ministry of Health and Long-Term Care. (2007). Family Health Organization (FHO) (Fact Sheet).
Newhouse, J. P. (1984). Cream skimming, asymmetric information, and a competitive insurance market. Journal of Health Economics, 3, 97-100. https://doi.org/10.1016/0167-6296(84)90030-4.
OECD. (2016). Better Ways to Pay for Health Care, OECD Health Policy Studies. Paris, FR: OECD Publishing. https://doi.org/10.1787/9789264258211-en.
Office of the Auditor General of Ontario. (2016). The 2016 annual report of the office of the auditor general of Ontario: Physicians billing. Toronto, ON: Office of the Auditor General of Ontario. Retrieved from https://www.auditor.on.ca/en/content/annualreports/arreports/en16/2016AR_v1_en_web.pdf.
Olejaz, M., Juul Nielsen, A., Rudkjøbing, A., Okkels Birk, H., Krasnik, A., & Hernández-Quevedo, C. (2012). Denmark health system review. Health Systems in Transition, 14.
Paris, V., Devaux, M., & Wei, L., (2010). Health systems institutional characteristics: a survey of 29 OECD countries (OECD Health Working Papers No. 50) 140. https://doi.org/10.1787/5kmfxfq9qbnr-en.
Peckham, S., & Gousia, K. (2014). GP payment schemes review, Policy research unit in commissioning and the healthcare system. London, UK.
Rice, T. (2012). The Physician as the Patient's Agent. Cheltenham, UK: Edward Elgar Publishing.
Richardson, E., Boerma, W., Malakhova, I., & Rusovich, V. (2008). Health system review. Health Systems in Transition, 10, 1-179.
Rizzo, J. A., & Blumenthal, D. (1996). Is the target income hypothesis an economic heresy? Medical Care Research and Review, 53, 243-266. https://doi.org/10.1177/107755879605300301.
Rochaix, L. (1989). Information asymmetry and search in the market for physicians' services. Journal of Health Economics, 8, 53-84. https://doi.org/10.1016/0167-6296(89)90009-X.
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41-55. https://doi.org/10.2307/2335942.
Rudoler, D., Deber, R., Barnsley, J., Glazier, R. H., Dass, A. R., & Laporte, A. (2015). Paying for primary care: The factors associated with physician self-selection into payment models. Health Economics, 1229-1242. https://doi.org/10.1002/hec.3221.
Sarma, S., Mehta, N., Devlin, R. A., Kpelitse, K. A., & Li, L. (2018). Family physician remuneration schemes and specialist referrals: Quasi-experimental evidence from Ontario, Canada. Health Economics, 27, 1533-1549. https://doi.org/10.1002/hec.3783.
Shearer, B., Somé, N. H., & Fortin, B. (2018). Measuring physicians' response to incentives: Evidence on hours worked and multitasking. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3211451.
Shen, J., Andersen, R., Brook, R., Kominski, G., Albert, P. S., & Wenger, N. (2004). The effects of payment method on clinical decision-making: Physician responses to clinical scenarios. Medical Care, 42, 297-302. https://doi.org/10.1097/01.mlr.0000114918.50088.1c.
Smith, J. A., & Todd, P. E. (2005). Does matching overcome LaLonde's critique of nonexperimental estimators? Journal of Econometrics, 125, 305-353. https://doi.org/10.1016/j.jeconom.2004.04.011.
Somé, N. H., Devlin, R. A., Mehta, N., Zaric, G., Li, L., Shariff, S., … Sarma, S. (2019). Production of physician services under fee-for-service and blended fee-for-service: Evidence from Ontario, Canada. Health Economics, 28, 1418-1434. https://doi.org/10.1002/hec.3951.
Sutton, M., Elder, R., Guthrie, B., & Watt, G. (2010). Record rewards: The effects of targeted quality incentives on the recording of risk factors by primary care providers. Health Economics, 19, 1-13. https://doi.org/10.1002/hec.1440.
Sweetman, A., & Buckley, G. (2014). Ontario's experiment with primary care reform (The School of Public Policy Research Paper No. 7). Calgary, AB: University of Calgary, pp. 1-35.
The Johns Hopkins University. (2011). The Johns Hopkins ACG® Case-Mix System Version 10.0 Release Notes. Baltimore, MD: The Johns Hopkins University.
Woodward, R. S., & Warren-Boulton, F. (1984). Considering the effects of financial incentives and professional ethics on ‘appropriate’ medical care. Journal of Health Economics, 3, 223-237.
Zhang, X., & Sweetman, A. (2018). Blended capitation and incentives: Fee codes inside and outside the capitated basket. Journal of Health Economics, 60, 16-29. https://doi.org/10.1016/j.jhealeco.2018.03.002.
Grant Information:: MOP-130354 Canada CIHR
Contributed Indexing:: Keywords: access to medical services; after-hours services; blended remuneration; capitation; comprehensive care; fee-for-service; financial incentives
Entry Date(s):: Date Created: 20200820 Date Completed: 20210818 Latest Revision: 20210818
Update Code:: 20240105
DOI:: 10.1002/hec.4145
PMID:: 32812685
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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. Using health administrative data from 2006 to 2014 and a two-stage estimation strategy, we study the impact of switching from FHG to FHO on the production of a capitated basket of services, after-hours services and nonincentivized services. Our results reveal that switching from the FHG to FHO reduces the production of capitated services to enrolled patients and services to nonenrolled patients by 15% and 5% per annum and increases the production of after-hours and nonincentivized services by 8% and 15% per annum.
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