title: Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.
abstract: The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model.
  
  
  
  Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening.
  
  
  
  Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06.
  
  
  
  We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs.
authors: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.
authors: Ciara
authors: C
authors: Pendrith
authors: Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Institute for Clinical Evaluative Sciences, Toronto, ON.
authors: Amardeep
authors: A
authors: Thind
authors: Ivey School of Business, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON.
authors: Gregory S
authors: GS
authors: Zaric
authors: Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Institute for Clinical Evaluative Sciences, Toronto, ON.
authors: Sisira
authors: S
authors: Sarma
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009042:Motivation; D009864:Ontario; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000191:economics* / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*