CCHE Seminar Series: Avoidable Hospitalizations and Primary Care Payment Models in Ontario, Canada: A Multivalued Treatment Effects Analysis

Avoidable Hospitalizations and Primary Care Payment Models in Ontario, Canada: A Multivalued Treatment Effects Analysis

Nibene Somé
Centre for Addiction and Mental Health, Western University and University of Toronto

Friday November 4, 2022, 10am-12pm, HS Room 108 and Zoom

Abstract: Improving access to primary care physician’s services is essential to reduce the risk of hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs) (i.e., avoidable hospitalizations). Ontario, Canada’s most populous province, introduced blended payment models for primary care physicians in the 2000s (i.e., blended FFS (Family Health Groups (FHGs), blended capitation models (Family Health Organizations (FHOs) and Family Health Networks (FHNs) have been combined), and the team-based practice model (Family Health Teams (FHTs))) to increase access to primary care, preventive care, and better chronic disease management. We study pairwise differences across payments models (i.e., FHGs vs FHOs and FHOs vs FHTs) in the rates of avoidable hospitalizations due to incentivized ACSCs (diabetes and congestive heart failure (CHF)) and non-incentivized ACSCs (angina and asthma). The data for our study came from the health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy to study the impact of primary care models on avoidable hospitalizations. First, we account for selection bias using a generalized propensity score model generated by a multinomial logistic model in the base year 2006 with the three payment models corresponding to different levels of treatment. Second, we use fractional regression models to estimate the average treatment effects on the treated of multivalued treatments. We find that changing the primary care model from FHG to FHO increases the rates of hospitalizations for angina and CHF by 0.01% and 0.04%. There is no significant difference in hospitalizations due to diabetes and asthma. Finally, changing the treatment from FHO to FHT also increased the rates of hospitalizations for angina and asthma by 0.01% and 0.004%. In contrast, it reduced hospital admissions for CHF by 0.03% and had no significant effect on hospitalizations for diabetes.

Dr. Nibene Habib Somé is a Scientist and Health Economist with the Institute for Mental Health Policy Research at CAMH and an Adjunct Assistant Professor in the Department of Epidemiology and Biostatistics at Western University. He is also an Adjunct Lecturer at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Somé applies economic, statistical/econometric, and machine learning methods in health economics, health policy, and health services research. His research covers three specific areas: evaluating health care financing policies – physician’s compensation policy and government financial incentives programs; optimal delivery of mental health care into primary care settings; and understanding the impact of COVID-19 on mental health, substance use, costs, and utilization. He has successfully designed studies using large administrative datasets, contributing theoretically and empirically to healthcare policy evaluation. He has published his work in leading journals such as Health Economics, Social Science & Medicine, and JMIR mental health. He has received research funding from CIHR, and the Ontario Ministry of Health.