Paying for primary care: The relationship between payment for primary care physicians and selection of patients based on case-mix

David Rudoler, Rasia B. Deber, Adrian Rohit Dass, Janet Barnsley, Richard H. Glazier, Audrey Laporte

This study analyzes whether primary care physicians respond to financial incentives to risk-select patients based on case-mix. We use administrative health data to compare primary care physicians across payment models in Ontario, Canada. We use a panel multinomial selection model to estimate the relationship between payment and risk-selection, while controlling for physician self-selection into payment types. After controlling for physician self-selection, we do not find evidence of risk-selection behaviour. These findings suggest that policy-makers need to be aware of self-selection when implementing payment reforms. Future work should consider the long-term effects of payment reform on access to care for patients with complex healthcare needs.

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Paper Keywords

physician behaviour, financial incentives, administrative data, panel data