Abstract
BackgroundThe general health check, which includes the periodic health visit and annual physical exam, is not recommended to maintain the health of asymptomatic adults with no risk factors. Different funding mechanisms for primary care may be associated with the provision of service delivery according to recommended guidelines. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model.MethodsPopulation-based cross-sectional study using linked health and administrative datasets in Ontario, Canada, where most residents are insured for physician services through Ontario’s single payer, provincially funded Ontario Health Insurance Plan. Participants included all living adults (> 19 years) in Ontario on January 1st, 2014, eligible for the Ontario Health Insurance Plan. Primary care enrollment model was the main exposure and included traditional fee-for-service, enhanced fee-for-service, capitation, team-based care, other (including salaried), and unenrolled. The main outcome measure was receipt of a periodic health visit during 2014. Age-sex standardized rates of periodic health visits performed during the one-year study period were analyzed by number of comorbid conditions.ResultsOf 10,712,804 adults in Ontario, 2,350,386 (21.9%) had a periodic health visit in 2014. The age-sex standardized rate was 6.1% (95% confidence interval [CI] 6.0, 6.1%) for healthy individuals. In the traditional fee-for-service model, the periodic health visit was performed for 55.3% (95% CI 54.4, 56.3%) of healthy individuals versus 10.2% (95% CI 10.0, 10.3%) in team-based care. Periodic health visit rates varied by primary care provider models. Traditional and enhanced fee-for-service models had higher rates across all comorbidity groups.ConclusionsPatients whose primary care physicians are funded exclusively through fee-for-service had the highest rates of periodic health visits in healthy individuals. Primary care reform initiatives must consider the influence of remuneration on providing evidence-based primary care.
Highlights
Increasing evidence suggests general health checks, which include both the traditional annual physical exam and the periodic health visit, do not reduce morbidity and mortality for patients and is a costly service [1,2,3]
Periodic health visit rates varied by Primary Care Provider (PCP) models
There was a 3-fold standardized rate difference observed within primary care models (35.4% for traditional fee-for-service, 12.2% for other enrollment model group)
Summary
Increasing evidence suggests general health checks, which include both the traditional annual physical exam and the periodic health visit, do not reduce morbidity and mortality for patients and is a costly service [1,2,3]. Saunders et al BMC Family Practice (2019) 20:42 are unlikely to be beneficial and are not supported based on the best available evidence This is important for healthy, low risk individuals in theChoosing Wisely [6] climate, where there is a focus to encourage clinicians and patients to consider reducing unnecessary tests and treatments and to make effective choices for high-quality care. The Ontario Health Insurance Plan (OHIP), the universal government funding program for physician and hospital services in the province, funds one annual periodic health visit per patient, regardless of comorbidities. This fee code was established in November 2012, despite available evidence challenging the utility of periodic health visits. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model
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