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

IF 2 3区 医学 Q2 ECONOMICS
Health economics Pub Date : 2024-06-19 DOI:10.1002/hec.4872
Nibene Habib Somé, Rose Anne Devlin, Nirav Mehta, Sisira Sarma
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引用次数: 0

Abstract

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). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.

加拿大安大略省的初级医疗支付模式与可避免的住院治疗:多值治疗效果分析。
改善初级保健医生服务的可及性可能有助于减少非住院护理敏感疾病(ACSCs)导致的住院治疗。安大略省是加拿大人口最多的省份,该省在 2000 年代初至中期引入了针对初级保健医生的混合支付模式,以提高初级保健、预防保健和更好的慢性病管理的可及性。我们研究了支付模式对两种激励性 ACSC(糖尿病和充血性心力衰竭)和两种非激励性 ACSC(心绞痛和哮喘)导致的可避免住院的影响。我们的研究数据来自 2006 年至 2015 年期间安大略省执业初级保健医生的卫生行政数据。我们对 3710 名全科医生(1158 名混合收费服务(FFS)医生、1388 名混合按人头付费模式医生和 1164 名跨专业团队执业医生)的平衡面板采用了两阶段估算策略。首先,我们使用基于多叉 logit 回归模型的广义倾向得分来解释医生实践的差异,该模型与三种初级医疗支付模式相对应。其次,我们使用分数回归模型来估算治疗结果(即可避免的住院治疗)的平均治疗效果。按人头付费模式有时会增加心绞痛(每 10 万名患者增加 7 例)和充血性心力衰竭(每 10 万名患者增加 40 例)的可避免住院率。将按人头付费医生转为跨专业团队可减轻这种影响,每 10 万名患者中因充血性心力衰竭而导致的可避免住院治疗减少了 30 例,这表明在以团队为基础的实践中可以更好地获得初级保健和慢性病管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health economics
Health economics 医学-卫生保健
CiteScore
3.60
自引率
4.80%
发文量
177
审稿时长
4-8 weeks
期刊介绍: This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.
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