Healthcare Policy has published a new study that looks at service-use by adults with serious mental illness who have been rostered in three primary care models: enhanced fee-for-service; blended-“capitation;” and, team-based “capitation” with and without mental health workers in Ontario. The study suggests a need to review financial incentive structures offered to physicians in order to get them to see more patients with series mental illnesses. In other words, physicians may need specific incentives and support in order to accept hard-to-place patients into their practice roster. This is especially important in the context of primary care reform.
In Ontario, primary care is delivered through several different models that all involve “rostering” patients but the models differ in their method of physician reimbursement.
With a basic capitation model, care providers are allocated a fixed amount of money based on a per capita (capitation) rate for each rostered patient. Providers then use this prepaid fixed amount to cover expenses, including remuneration for doctors and nurses, operating and administration costs, and all costs related to treating the rostered population. Some argue that because providers assume financial risk (since they are not paid for costs beyond the capitation revenue) it gives them incentive to underprovide for or avoid patients with complex needs.
This cross-sectional study compared the use of mental health and general health services among persons with series mental illnesses enrolled in one of the three models. The results showed:
- Compared to people registered in enhanced fee-for-service, those in blended-capitation and team-based capitation had fewer mental health primary care visits
- Compared to patients in enhanced fee-for-service, those in team-based capitation models also had more mental health hospital admissions
- Patterns of use of general services were similar
The journal article can be found here.