BC incentive program does little to improve healthcare: study

VANCOUVER (NEWS 1130) – A program which shelled out millions to B.C. doctors to take on tougher cases did little to reduce hospital visits, improve care or boost access for patients with multiple chronic illnesses, research from SFU says.

The study, led by Ruth Lavergne, looked at the first year the Complex Care Initiative program and found allowing doctors to charge $315 per year to manage patients with two or more chronic health problems only increased family doctors’ salaries and didn’t reduce health costs or improve care. Despite the province having already spent $240 million on the program, researchers concluded the government should look at other ways to improve care.

“Moving forward, it’s important that we think about what the goals of policies are and track them over time so when we try new things quickly whether they’re having the effects we hope for,” Lavergne says.

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The study looked at all patients who qualified for the program in the first year. Of the 155,754 eligible patients, 63.7 per cent had a doctor who charged taxpayers at least one incentive fee.

The program, created in partnership between the province and the Doctors of B.C. – then the B.C. Medical Association – was designed to reward family doctors for taking on complex cases, keep them from moving to walk-in clinics for more money and less work, and cut costs by reducing emergency room visits.

Lavergne did highlight how patients seeing doctors who charged the incentives also had better care, but says they may have already been getting that high quality care before the incentive.

General Practice Services Committee co-chair Dr. Shelley Ross says the study didn’t examine a long enough time period and was too narrow.

“Incentives are just a very small part of the overall changes we’re making to primary care,” she says. “Doctors of B.C., the government and the health authorities are all working together to try and make primary care more efficient and organized for the patient.”

Similar studies in Ontario and of the United Kingdom’s pay for performance program yielded similar results to the SFU study, Lavergne noted. U.K. and American studies provided mixed results of the effectiveness of incentive programs.
Lavergne says she hopes their research leads to more efficient tracking of policy results and understands the complexity of solving health care issues.

“I hope that we’re not afraid to try new things, but the important thing is we consider what the goals are and track them carefully so that we know if policies are having their intended effect,” she says. “I think there’s recognition that other care providers have a really important role to play in delivery primary care.”

Lavergne would also like to see patients play a larger role in the discussion of the future of health care.

Similar studies in Ontario and of the United Kingdom’s pay for performance program yielded similar results to the SFU study, Lavergne noted. U.K. and American studies provided mixed results of the effectiveness of incentive programs.

Lavergne says she hopes their research leads to more efficient tracking of policy results and understands the complexity of solving health care issues.

“I hope that we’re not afraid to try new things, but the important thing is we consider what the goals are and track them carefully so that we know if policies are having their intended effect,” she says. “I think there’s recognition that other care providers have a really important role to play in delivery primary care.”

Lavergne would also like to see patients play a larger role in the discussion of the future of health care.