How Does Ontario Primary Care Perform? Effectiveness, Costs and Efficiency

In 2001, Ontario began introducing new primary care models characterized by physician remuneration mechanisms, interdisciplinary teams, access requirements, and patient enrolment. The objectives of the primary care reform were to improve the quality of and access to primary care and to make primary care more attractive as a physician specialty. This thesis explores the performance of the new primary care models – enhanced fee-for-service (FFS), blended capitation, and interdisciplinary teams - compared to the traditional FFS model. The effectiveness, costs and efficiency are reviewed separately in three distinct studies. The study about effectiveness aims to measure the risk of having a hospitalization for an ambulatory care sensitive condition (ACSC). The risk of having an ACSC hospitalization was lower for patients whose physician practiced in an enhanced-FFS or in a capitation model compared to patients whose saw a FFS physician. It was higher for patients who saw physicians who worked in interdisciplinary teams. The second study examined primary care costs and total health care costs for a randomly selected 10% sample of the Ontario adult population. The costs were calculated at the individual level based on the prices of the services and the utilization. Compared to patients of FFS physicians, patients in capitation models had higher primary care costs but lower total health care costs. Enhanced-FFS patients had the lowest primary care costs and total health care costs. The third study employed a Stochastic Frontier Analysis (SFA) to assess the efficiency of physicians. The analyses were supported by survey data on a physician’s hours worked on direct patient care, duration of the visits and other characteristics of a physician’s practice and linked to administrative data on patient visits. After controlling for input and explanatory variables, efficiency scores were on average higher for physicians in blended capitation models and in interdisciplinary teams compared to physicians in FFS. The three studies show significant differences across models for each of the outcomes examined (ACSC hospitalization; primary care costs and total health care costs; efficiency). More research is needed to understand these variations and the causal relationships in these variations, in order to better inform policy.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2015

Author dc:creator

• Laberge, Maude Pascale

Advisor dc:contributor.advisor

• Wodchis, Walter P

• costs
• efficiency
• patient outcomes
• performance measurement
• primary care

Handle dc:identifier.uri

http://hdl.handle.net/1807/71027

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/71027