CCHE Seminar Series: Primary Care Use with Outside Providers: A Multilevel Analysis of Family Health Organizations in Ontario

Primary Care Use with Outside Providers: A Multilevel Analysis of Family Health Organizations in Ontario

Shaun Shaikh
Ontario Medical Association

Friday April 1, 2022, 10am-12pm, Zoom

Abstract: Family Health Organizations (FHOs) in Ontario incentivize continuity of care through an access bonus payment to physician groups, which is reduced dollar-for-dollar by outside use, defined as enrolled patients receiving core primary care services from physicians outside the group. How patient and physician group factors impact outside use is not well understood. A logistic multilevel regression model was used to quantify the relative impact of factors at the patient, physician, group, and geographic levels in predicting the probability of outside use from April 1st, 2018 to March 31st, 2019. Roughly one-in-five (20.2%) of individuals enrolled in FHOs had any outside use. Patient-level variation explained approximately 82.4% of the probability of outside use. The remaining variation was primarily at the group geography level (14.2%). Physician and group levels each explained less than an additional <2% of outside use. While all observed patient factors were robustly associated with outside use, significance of group factors was sensitive to multi-level specification. Outside use is primarily explained by variation at the patient level. Further efforts are needed to understand observable factors that translate to patient choice in seeking continuous primary care services and develop policy channels that can effectively direct patients to continuous care options.

Shaun Shaikh, MA, is a Senior Economist in the Economics, Policy & Research department at the Ontario Medical Association (OMA). He works in the Healthcare Evaluative Research group, which produces scientific publications on topics relevant to the Ontario healthcare system. Prior to joining the OMA, Shaun worked as Teaching Assistant at McMaster University, and as a research assistant at Northwestern and McMaster University. At Northwestern he supported the research of Dr. Charles Manski by helping to build a Life Prediction Tool to support which could support clinical decision-making. At McMaster, he worked for Dr Arthur Sweetman on topics related to Ontario Primary Care Reform using administrative health data provided by the Ministry of Health and Long-Term Care. Shaun grew up in Southwestern Ontario, and completed a bachelor’s degree in mathematics and economics, from the University of Waterloo. He completed a master’s in economics from McMaster and is expecting to defend his PhD in Economics in 2022, with specialization in health economics and econometrics.