Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Sisira Sarma


Physicians practicing in capitation-based Family Health Organizations and fee-for-service-based Family Health Groups receive bonuses for delivering preventive care, including cervical cancer screening, while those practicing in the traditional fee-for-service model do not. Financial incentives were introduced to increase Ontario’s cervical screening rate to 85%. To date, the impact of incentives for cervical screening on screening rate and cost-effectiveness have not been assessed. Patient-level data obtained from the Institute for Clinical Evaluative Sciences were used to estimate primary care model screening rates and cancer treatment costs. A microsimulation model was developed from published cervical cancer natural history models and parameterized using Ontario data. My results show significant differences in Pap smear rates across primary care model type, and that financial incentives are associated with slightly greater quality-adjusted life years. In conclusion, primary care models featuring incentives are associated with higher screening rates and appear cost-effective compared to the traditional FFS model.