Efficiency of Ontario primary care physicians across payment models: a stochastic frontier analysis.

Maude Laberge,Jan Barnsley,Walter P Wodchis,Audrey Laporte

doi:10.1186/s13561-016-0101-y

Abstract

ObjectiveThe study examines the relationship between the primary care model that a physician belongs to and the efficiency of the primary care physician in Ontario, Canada.MethodsSurvey data were collected from 183 self-selected physicians and linked to administrative databases to capture the provision of services to the patients served for the 12 month period ending June 30, 2013, and the characteristics of the patients at the beginning of the study period. Two stochastic frontier regression models were used to estimate efficiency scores and parameters for two separate outputs: the number of distinct patients seen and the number of visits.ResultsBecause of missing data, only 165 physicians were included in the analyses. The average efficiency was 0.72 for both outputs with scores varying from 4 % to 93 % for the visits and 5 % to 94 % for the number of patients seen. We observed that there were both very low and very high efficiency scores within each model. These variations were larger than variations in average scores across models.

Highlights

Concerns over growing health care expenditures have led to interest in increasing the efficiency of health care providers, in developed countries such as Canada [1]
Half of the physicians excluded were from salaried models and Community Health Centres (CHCs)
CHC physicians do not directly bill Ontario Health Insurance Plan (OHIP) and claims records are not generated which reduced the number of salaried physicians from 11 to 6

Summary

Introduction

Concerns over growing health care expenditures have led to interest in increasing the efficiency of health care providers, in developed countries such as Canada [1]. The majority of primary care has been delivered by primary care physicians in solo or group practices who were traditionally remunerated on a fee-forservice basis [2]. Since the early 2000s, there has been a shift in the organization and payment of primary care physicians, with Ontario considered the province to have. Various factors can affect the efficiency of primary care physicians, including remuneration methods and the organizational characteristics of the primary care practice, as well as the nature of the outputs measured. Over the past fifteen years, primary care in Ontario has been transformed away from almost exclusively fee-for-service towards mixed payments and new models of organization with interdisciplinary teams. The new primary care models feature group and interdisciplinary teams, enrollment of patients with the physicians, and after-hours access requirements

Methods

Results

Discussion

Conclusion