Evaluation of the equity of age-sex adjusted primary care capitation payments in Ontario, Canada

Health Policy

Volumn 104, Issue 2, 2012, Pages 186-192

  Sibley, Lyn M ^a,b   Glazier, Richard H ^a,b,c,d  

^a INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES   (Canada)

^b UNIVERSITY OF TORONTO   (Canada)

^c UNIVERSITY OF TORONTO   (Canada)

^d ST MICHAEL'S HOSPITAL   (Canada)

Author keywords

Access; Canada; Capitation; Primary health care; Risk adjustment; Socioeconomic status; Vulnerable populations

Indexed keywords

ADOLESCENT; ADULT; AGE; AGED; ARTICLE; CANADA; CAPITATION FEE; CHILD; COHORT ANALYSIS; CONTROLLED STUDY; FAMILY HEALTH; FAMILY HEALTH NETWORK; FEMALE; GENDER; GENERAL PRACTITIONER; HEALTH CARE NEED; HEALTH CARE UTILIZATION; HUMAN; INFANT; INFORMATION PROCESSING; LOWEST INCOME GROUP; MALE; MORBIDITY; ONTARIO AGE SEX ADJUSTED CAPITATION REMUNERATION RATE INDEX; PRESCHOOL CHILD; PRIMARY HEALTH CARE; RATING SCALE; SCHOOL CHILD; SOCIAL STATUS; THE JOHNS HOPKINS ADJUSTED CLINICAL GROUP CASE MIX SYSTEM;

ADOLESCENT; ADULT; AGE FACTORS; AGED; AGED, 80 AND OVER; CAPITATION FEE; CHILD; CHILD, PRESCHOOL; FEMALE; HUMANS; INCOME; INFANT; INFANT, NEWBORN; MALE; MIDDLE AGED; POVERTY; PRIMARY HEALTH CARE; RISK ADJUSTMENT; SEX FACTORS; SOCIOECONOMIC FACTORS; YOUNG ADULT;

EID: 84855579684     PISSN: 01688510     EISSN: 18726054     Source Type: Journal    
DOI: 10.1016/j.healthpol.2011.10.008     Document Type: Article

References (38)

1. Canada Health Act. [last accessed: 7-20-2011]. http://laws.justice.gc.ca/eng/C-6/index.html.
2. Weiner J.P. A shortage of physicians or a surplus of assumptions?. Health Affairs (Millwood) 2002, 21:160-162.
3. Chan B.T. The declining comprehensiveness of primary care. Canadian Medical Association Journal 2002, 166:429-434.
4. Bodenheimer T. Primary care-will it survive?. New England Journal of Medicine 2006, 355:861-864.
5. Denton F.T., Gafni A., Spencer B.G. Users and suppliers of physician services: a tale of two populations. International Journal of Health Services 2009, 39:189-218.
6. Dahrouge S., Hogg W., Russell G., Geneau R., Kristjansson E., Muldoon L., et al. The comparison of models of primary care in Ontario (COMP-PC) study: methodology of a multifaceted cross-sectional practice-based study. Open Medicine 2009, 3:149-164.
7. Starfield B. Primary care: balancing health needs, services, and technology 1998, Oxford University Press, New York, USA.
8. Wranik D.W., Durier-Copp M. Physician remuneration methods for family physicians in Canada: expected outcomes and lessons learned. Health Care Analysis 2010, 18:35-59.
9. Sarma S., Devlin R.A., Hogg W. Physician's production of primary care in Ontario, Canada. Health Economics 2010, 19:14-30.
10. Rice N., Smith P.C. Capitation and risk adjustment in health care financing: an international progress report. Milbank Quarterly 2001, 79:81-113.
11. Glazier R.H., Klein-Geltink J., Kopp A., Sibley L.M. Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation. Canadian Medical Association Journal 2009, 180:E72-E81.
12. Reid R.J., MacWilliam L., Verhulst L., Roos N., Atkinson M. Performance of the ACG case-mix system in two Canadian provinces. Medical Care 2001, 39:86-99.
13. Reid R., Bogdanovic B., Roos N.P., Black C., MacWilliam L., Menec V. Do some physician groups see sicker patietns than others? Implications for primary care policy in Manitoba 2001, Manitoba Centre for Health Policy and Evaluation, Winnipeg, MB.
14. Zielinski A., Kronogard M., Lenhoff H., Halling A. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care. BMC Public Health 2009, 9:347.
15. Kuttner R. The risk-adjustment debate. New England Journal of Medicine 1998, 339:1952-1956.
16. Iezzoni L.I. Risk adjustment for measuring health care outcomes 2003, Health Administration Press, Chicago, IL.
17. Mackenbach J.P., Stirbu I., Roskam A.J., Schaap M.M., Menvielle G., Leinsalu M., et al. Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine 2008, 358:2468-2481.
18. Berkman L.F., Kawachi I. Social epidemiology 2000, Oxford University Press, New York.
19. Humphries K.H., van D.E. Income-related health inequality in Canada. Social Science & Medicine 2000, 50:663-671.
20. Romanow R.J. Building on values: the future of health care in Canada 2002, Commission on the Future of Health Care in Canada, Ottawa, Canada.
21. Wilkins R. PCCF+ version 5C user's guide: automated geographic coding based on the statistics Canada Postal Code Conversion Files 2008, Statistics Canada, Ottawa, ON.
22. Reid R.J., Roos N.P., MacWilliam L., Frohlich N., Black C. Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba. Health Services Research 2002, 37:1345-1364.
23. Reid R.J., Verhulst L., Forrest C.B. Comparing apples with apples in clinical populations: applications of the adjusted Clinical Group System in British Columbia. Healthcare Management Forum 2002, 15:11-16.
24. Starfield B., Lemke K.W., Bernhardt T., Foldes S.S., Forrest C.B., Weiner J.P. Comorbidity: implications for the importance of primary care in 'case' management. Annals of Family Medicine 2003, 1:8-14.
25. Starfield B., Lemke K.W., Herbert R., Pavlovich W.D., Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Annals of Family Medicine 2005, 3:215-222.
26. Wolff J.L., Starfield B., Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine 2002, 162:2269-2276.
27. The Johns Hopkins Adjusted Clinical Groups (ACG) Case-Mix System. [last accessed: 7-20-2011]. http://www.acg.jhsph.edu/.
28. Weiner J.P., Starfield B.H., Steinwachs D.M., Mumford L.M. Development and application of a population-oriented measure of ambulatory care case-mix. Medical Care 1991, 29:452-472.
29. Starfield B., Weiner J., Mumford L., Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Services Research 1991, 26:53-74.
30. Memorandum of agreement between The Ontario Medical Association (The "OMA")-and-Her Majesty the Queen in Right of Ontario, as represented by The Minister of Health and Long-Term Care (The "MOHLTC") 2005, Coalition of Family Physicians.
31. Finkelstein M.M. Ecologic proxies for household income: how well do they work for the analysis of health and health care utilization?. Canadian Journal of Public Health 2004, 95:90-94.
32. Mustard C.A., Derksen S., Berthelot J.M., Wolfson M. Assessing ecologic proxies for household income: a comparison of household and neighbourhood level income measures in the study of population health status. Health & Place 1999, 5:157-171.
33. Fowles J.B., Weiner J.P., Knutson D., Fowler E., Tucker A.M., Ireland M. Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods. Journal of the American Medical Association 1996, 276:1316-1321.
34. van de Ven W.P., Beck K., Buchner F., Chernichovsky D., Gardiol L., Holly A., et al. Risk adjustment and risk selection on the sickness fund insurance market in five European countries. Health Policy 2003, 65:75-98.
35. van de Ven W.P., Beck K., Van d V., Wasem J., Zmora I. Risk adjustment and risk selection in Europe: 6 years later. Health Policy 2007, 83:162-179.
36. Anderson G.F., Steinberg E.P., Holloway J., Cantor J.C. Paying for HMO care: issues and options in setting capitation rates. Milbank Quarterly 1986, 64:548-565.
37. Gifford G.A., Edwards K.R., Knutson D.J. Health-based capitation risk adjustment in Minnesota public health care programs. Health Care Financing Review 2004, 26:21-41.
38. Reid R., MacWilliam L., Roos N., Bogdanovic B., Black C. Measuring morbidity in populations: performance of the Johns Hopkins Adjusted Clinical Groups (ACG) case-mix adjustment system in Manitoba 1999, University of Manitoba, Winnipeg, MB.