Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; ICES, Toronto, ON, Canada.
Soc Sci Med. 2021 Jan;268:113465. doi: 10.1016/j.socscimed.2020.113465. Epub 2020 Oct 20.
Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration model, relative to those who remained in the blended FFS model, on psychiatric hospitalizations. Outcomes included psychiatric hospitalizations by enrolled patients and the proportion of hospitalized patients who had a follow-up visit with the FP within 14 days of discharge. We used longitudinal health administrative data from a cohort of practicing physicians from 2006 through 2016. Because physicians practicing in these two models are likely to be different, we employed inverse probability weighting based on estimated propensity scores to ensure that switchers and non-switchers were comparable at the baseline. Using inverse probability weighted fixed-effects regressions controlling for relevant confounders, we found that switching from blended FFS to blended capitation was associated with a 6.2% decrease in the number of psychiatric hospitalizations and a 4.7% decrease in the number of patients with a psychiatric hospitalization. No significant effect of remuneration on follow-up visits within 14 days of discharge was observed. Our results suggest that the blended capitation model is associated with fewer psychiatric hospitalizations relative to blended FFS.
如果精神疾病能在初级保健环境中更早地被发现和治疗，那么精神科住院治疗的人数就可能减少，这促使世界卫生组织建议将精神卫生服务纳入初级保健。初级保健环境中提供的精神卫生服务可能因医生的激励方式而异。对于医生薪酬与精神科住院治疗之间的联系，人们知之甚少。我们通过研究加拿大人口最多的安大略省医生薪酬与精神科住院治疗之间的关系，为这一文献做出了贡献。具体来说，我们研究了从混合按服务收费（FFS）向混合人头费薪酬模式转变的家庭医生（FP），与仍留在混合 FFS 模式的医生相比，他们的精神科住院治疗情况。结果包括登记患者的精神科住院治疗情况以及在出院后 14 天内与 FP 进行随访的住院患者比例。我们使用了来自 2006 年至 2016 年期间执业医生的纵向健康管理数据。由于两种模式下的医生可能存在差异，因此我们根据估计的倾向得分使用逆概率加权，以确保在基线时转换者和非转换者具有可比性。使用逆概率加权固定效应回归，控制了相关混杂因素，我们发现从混合 FFS 向混合人头费的转变与精神科住院人数减少 6.2%和精神科住院患者人数减少 4.7%相关。在出院后 14 天内进行随访的薪酬没有显著影响。我们的研究结果表明，与混合 FFS 相比，混合人头费模式与较少的精神科住院治疗相关。
