Department of Epidemiology & Biostatistics, University of Western Ontario, London, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Health Econ. 2020 Nov;29(11):1435-1455. doi: 10.1002/hec.4145. Epub 2020 Aug 19.
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.
在加拿大人口最多的安大略省，家庭医生可以选择混合按服务收费（家庭健康小组[FHG]）和混合人头付费（家庭健康组织[FHO]支付模式）。这两种模式都激励医生提供下班后（AH）和综合护理，但 FHO 医生根据年龄和性别为每个注册患者收取人头费，并收取较低的按服务收费，而 FHG 医生则按按服务收费收取费用。我们建立了一个具有多任务的医生劳动力供应理论模型，以预测他们在 FHG 和 FHO 下的行为，并推导出可估计的方程来对预测进行实证检验。使用 2006 年至 2014 年的健康管理数据和两阶段估计策略，我们研究了从 FHG 切换到 FHO 对人头费篮子服务、下班后服务和非激励服务的生产的影响。我们的结果表明，从 FHG 切换到 FHO 每年会减少向注册患者和非注册患者提供的人头费服务和服务，分别减少 15%和 5%，并增加 8%和 15%的下班后服务和非激励服务的生产。
