Dr. Tara Kiran
Health systems in Canada, the United States and elsewhere are exploring how to deliver better primary care by changing the way doctors are paid and organized. Many are moving away from fee-for-service payment toward salaried or capitation payment. Capitation means paying physicians an annual fee per patient, rather than payment for each service provided, regardless of the number of patient visits. Capitation is thought to better support chronic disease care.
Since 2002, 45 per cent of primary care physicians in Ontario have moved to capitation payment. About half of these physicians are part of a family health team where they deliver care together with other health professionals.
A 10-year study involving more than 10 million patients looked at whether the shift to capitation models for physicians in a health care team improved patient outcomes.
The study, published today in the Canadian Medical Association Journal, used data from the Ontario Health Insurance Plan and the Institute for Clinical Evaluative Sciences.
“We know that only about one in five Ontarians receive primary care from a family health team,” said Dr. Tara Kiran, a family physician at the St. Michael’s Hospital Academic Family Health Team. “Our study suggests that Ontarians might be healthier if everyone had access to team-based care”
Patients who had physicians in a family health team were more likely to be monitored for diabetes (40 per cent) compared with those in a fee-for-service practice (32 per cent). Family health team patients also experienced greater improvements in diabetes care between 2001 and 2011 than patients in a fee-for-service practice.
The findings for cancer screening were mixed. In 2011, patients in family health teams had higher rates of mammography (77 per cent vs. 72 per cent) and colorectal cancer screening (63 per cent vs. 61 per cent) than patients in a fee-for-service practice. However, these differences in care seemed to be present for patients in 2001, before family health teams were introduced.
“Our findings suggest that the shift to capitation payment and the addition of non-physician health professionals to the care team have led to modest improvements in diabetes care,” said Dr. Tara Kiran. “However, there does not appear to have been much of an effect on cancer screening.”
The researchers note there are large differences in the characteristics of physicians and patients in family health teams compared with those who are not in family health teams. For example, patients in family health teams were more likely to be Canadian-born, live in rural areas and have fewer health problems. These differences may have influenced the findings despite the authors’ attempts to account for these differences.
The authors suggest that changing the way physicians are paid and adding other health professionals to the team has the potential to improve quality of care, although this needs to be weighed against the cost of reforms within the system.
This study received funding from the Canadian Institutes of Health Research and was supported by the Institute for Clinical Evaluative Sciences and St. Michael’s Hospital.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
For more information or to arrange an interview with Dr. Kiran, please contact:
Communications Advisor – Media