title: A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease.
abstract: BACKGROUND
  In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs.
  
  
  METHODS
  We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention.
  
  
  RESULTS
  Of 155 754 eligible patients, 63.7% had at least 1 incentive payment billed. Incentive payments had no impact on primary care contacts (change in contacts per patient per month: 0.016, 95% confidence interval [CI] -0.047 to 0.078) or continuity of care (mean monthly change: 0.012, 95% CI -0.001 to 0.024) and were associated with increased total rates of hospital admission (change in hospital admissions per 1000 patients per month: 1.46, 95% CI 0.04 to 2.89), relative to preintervention trends. Annual costs per patient did not decline (mean change: $455.81, 95% CI -$2.44 to $914.08).
  
  
  CONCLUSIONS
  British Columbia's $240-million investment in this program improved compensation for physicians doing the important work of caring for complex patients, but did not appear to improve primary care access or continuity, or constrain resource use elsewhere in the health care system. Policymakers should consider other strategies to improve care for this patient population.
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont. ruth_lavergne@sfu.ca.
authors.forename: M Ruth
authors.initials: MR
authors.lastname: Lavergne
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Sandra
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Scott
authors.initials: S
authors.lastname: Garrison
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hurley
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine (Lavergne, Law, Peterson, Cheng, McGrail), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Lavergne), Simon Fraser University, Burnaby, BC; Department of Family Medicine (Garrison), University of Alberta, Edmonton, Alta.; Department of Economics (Hurley), McMaster University, Hamilton, Ont.
authors.forename: Kimberlyn
authors.initials: K
authors.lastname: McGrail
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology / Q000628:therapy; D001955:British Columbia / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000191:economics / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D065186:Interrupted Time Series Analysis; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000628:therapy; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D012052:Reimbursement, Incentive; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy