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Enhanced FFS Model and Patient Access: Evidence from FHG Model in Ontario. Jasmin Kantarevic, Boris Kralj, Darrel Weinkauf Ontario Medical Association. Outline. Patient Enrolment Models in Ontario Comparison of FFS and FHG Models Data and Empirical Framework Results

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enhanced ffs model and patient access evidence from fhg model in ontario

Enhanced FFS Model and Patient Access: Evidence from FHG Model in Ontario

Jasmin Kantarevic, Boris Kralj, Darrel Weinkauf

Ontario Medical Association

outline
Outline

Patient Enrolment Models in Ontario

Comparison of FFS and FHG Models

Data and Empirical Framework

Results

FHG physicians provide more services, visits, and see more patients than comparable FFS physicians.

No adverse impact on referral rates or patient selection.

primary care renewal in ontario
Primary Care Renewal in Ontario
  • Started in early 2000s
  • The focus is on how to pay family physicians
  • Goals of new reform:
    • Improved access
    • Improved quality
    • Lower cost
  • Rejection of pure FFS, capitation, or salary
  • Introduction of Patient Enrolment Models (PEM)
patient enrolment models
Patient Enrolment Models

Base Payment (FFS, Capitation, or Salary)

+ Additional Elements:

in this paper
In This Paper:

Zoom in on Family Health Groups

Introduced in 2003

Enhanced FFS model

Most popular model for family physicians

Usually the first stop from FFS to PEM

Focus on access to physician services

Services, visits, patients

slide9
Data
  • Ontario Health Insurance Plan (OHIP) Claims
  • Fiscal 1992/3 to 2008/9
    • Almost all family physicians in Ontario
    • 11 years before and 5 years after introduction of FHG
    • Lots of detail at the service level
    • Payment/administrative data
    • Minimal demographics (age, sex, postal code)
empirical strategy
Empirical Strategy

y log of outcome (services, visits, distinct patients)

 physician fixed effects

 year fixed effects

 physician-specific linear trend

w time-varying controls

FHG =1 if FHG, = 0 if FFS

 Difference in difference estimate of FHG impact

selecting comparison sample
Selecting Comparison Sample
  • Sample of all family physicians in 2002
  • Propensity to Ever Join FHG
    • Covariates = age, gender, expected income gain, after-hour days, 14 geographic (LHIN) indicators
  • Selecting Comparison Sample
    • Nearest neighbor matching
    • Replacement Option
  • Follow this sample over 1992-2008 period
implications
Implications
  • How we pay physicians may affect patient access
    • FHG a promising alternative to traditional FFS model
  • Access important in many jurisdictions:
    • Aging physician population
    • Increasing number of female physicians
    • Changing preferences
future research
Future Research
  • Impact of FHG incentives on cost and quality
  • Study of entire spectrum of PEM models
    • Determinants of transition
    • Impact of transition on physician behaviour