title: Paying for Primary Care: The Factors Associated with Physician Self-selection into Payment Models.
abstract: To determine the factors associated with primary care physician self-selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self-selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation-based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Canadian Centre for Health Economics, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Rudoler
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Canadian Centre for Health Economics, Toronto, Canada.
authors.forename: Raisa
authors.initials: R
authors.lastname: Deber
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Barnsley
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada.|Family and Community Medicine, University of Toronto, Toronto, Canada.|Family and Community Medicine, St. Michael's Hospital (University of Toronto), Toronto, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Canadian Centre for Health Economics, Toronto, Canada.
authors.forename: Adrian Rohit
authors.initials: AR
authors.lastname: Dass
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.|Canadian Centre for Health Economics, Toronto, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Laporte
mesh_terms: D002204:Capitation Fee / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D008962:Models, Theoretical; D009864:Ontario; D011320:Primary Health Care / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000191:economics* / Q000706:statistics & numerical data
keywords: financial incentives; physician payment; primary care; risk selection; self-selection