Analysis of Billings Data to Evaluate Patterns of Mental Health Services in Primary Care and Emergency Departments by Blended Fee-For-Service and Blended Capitation Models in Ontario, Canada
Abstract
Treating mental illness in primary care improves access to care, but it is unclear how to encourage family physicians to provide adequate mental health services. One approach may be changing how they are remunerated. The objectives of this thesis were to: 1) review the literature on the association between physician remuneration and provision of mental health services, and 2) assess the impact of blended capitation, compared to blended fee-for-service (FFS), on mental health services provision in Ontario. The review found that capitation appears to be associated with fewer services compared to FFS; however, studies of ED visits for mental health reasons were limited. The impact of remuneration models of Ontario physicians was assessed using longitudinal administrative data from ICES and analyzed using fixed-effects linear regression models. Blended capitation was associated with fewer mental health services provided and a slight decrease in the number of ED visits for mental health reasons.