Abstract
Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario’s blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data from 2007 to 2016. We accounted for the differences between those who switched to blended capitation and non-switchers in the baseline using propensity score weighted fixed-effects regressions to compare remuneration models. We found that switching from blended fee-for-service to blended capitation was associated with a 14% decrease (95% CI 12–14%) in the number of mental health services and an 18% decrease (95% CI 15–20%) in the corresponding value of services. This result was driven by the decrease in services during regular-hours. During after-hours, the number of services increased by 20% (95% CI 10–32%) and the corresponding value increased by 35% (95% CI 17–54%). Switching was associated with a 4% (95% CI 1–8%) decrease in emergency department visits for mental health reasons. Blended capitation reduced provision of mental health services without increasing emergency department visits, suggesting potential efficiency gain in the blended capitation model in Ontario.
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Notes
Results were qualitatively similar to increasing to 500 enrolled patients or reducing to 100 enrolled patients.
Material deprivation is a composite score based on the proportion aged 25 + years old without a certificate, diploma, or degree; the proportion of single-parent families; the proportion receiving government transfer payments, the proportion those aged 15 + who are unemployed, the proportion considered low-income, and the proportion living in homes of in need of major repair; ethnic concentration is a composite score based on neighbourhood level proportions, including the proportion who are recent immigrants (within 5 years) and the proportion of those who identify as self-minorities(Matheson et al. 2012).
This interpretation is based on the Halvorsen–Palmquist adjustment for interpreting a dummy variable in a semi-logarithmic model (Halvorsen and Palmquist 1980).
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Acknowledgements
We thank the comments and suggestions of Editor Eric Slade and an anonymous reviewer to improve the manuscript. Funding for this research by the Canadian Institutes of Health Research operating Grant (MOP-130354) and Early Researcher Award by the Ontario Ministry of Research and Innovation is gratefully acknowledged. Thyna would like to acknowledge the Western Graduate Research Scholarship at the University of Western Ontario. This work is a revised version of Thyna’s MSc thesis research submitted to the University of Western Ontario. We thank Jasmin Kantarevic for sharing the codes to estimate the expected gain in income variable. This study was undertaken at the ICES Western. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI). The opinions, results and conclusions are those of the authors and are independent from the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, CIHR, or the MOHLTC is intended or should be inferred.
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The results are reported according to the Strength in Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Appendix A0): von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med. 2007;4(10):1623–1627.
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Vu, T., Anderson, K.K., Somé, N.H. et al. Mental Health Services Provision in Primary Care and Emergency Department Settings: Analysis of Blended Fee-for-Service and Blended Capitation Models in Ontario, Canada. Adm Policy Ment Health 48, 654–667 (2021). https://doi.org/10.1007/s10488-020-01099-y
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DOI: https://doi.org/10.1007/s10488-020-01099-y