Abstract
BackgroundNorth American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians’ enrolment of orphan patients through centralized waiting lists, the Guichet d’accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians’ after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled.MethodsA longitudinal quantitative analysis spanning a five-year period (2008–2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used.ResultsThe number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level.ConclusionCentralized waiting lists linked to financial incentives increased the number of family physicians’ patient enrolments. However, although vulnerable patients were supposed to be given precedence, physicians favoured enrolment of healthier patients over those with greater health needs and higher assessed priority. These results suggest that introducing financial incentives without appropriate regulations may lead to opportunistic use of the incentive system with unintended policy consequences.
Highlights
North American patients are experiencing difficulties in securing affiliations with family physicians
Study design: a before–after study of financial incentive changes In this paper we report on the results of a before–after analysis of data from a provincial database of centralized waiting lists to determine whether changes could be observed in patients’ enrolment with family physicians after the financial incentives were modified
The results show that nearly 45% of the patients enrolled with family physicians through Guichet d’accès aux clientèles orphelines (GACO) during the last year were patients assessed as being in good health, whose health status did not require even non-urgent care
Summary
North American patients are experiencing difficulties in securing affiliations with family physicians. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians’ enrolment of orphan patients through centralized waiting lists, the Guichet d’accès aux clientèles orphelines, with higher payments for vulnerable patients. To address these difficulties in accessing continuous primary care services, for more vulnerable clienteles, four Canadian provinces have created centralized waiting lists to improve access to family physicians: Breton et al BMC Family Practice (2015) 16:10. Health Care Connect in Ontario, Healthcare NB in New Brunswick, A GP for Me in British Columbia, and the Guichet d’accès aux clientèles orphelines (GACO) in Quebec These waiting lists centralize requests for family physicians in a given territory and match unattached patients with family physicians based on a priority scale and on the availability of primary care resources [11]. The greatest challenge in using financial incentives is to carefully define and effectively align the modalities with the targeted objectives to avoid unintended consequences, such as over- or under-utilization of services [17]
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