Steven Habbous

Physician payment models and preventive cancer screening: a population-based retrospective cohort analysis from Ontario, Canada

Abstract Background Ontario's primary care reforms have introduced three blended physician payment models: (i) blended fee-for-service (BFFS), (ii) blended capitation without interprofessional teams, and (iii) blended capitation with teams. Each model includes the same pay-for-performance incentives, yet their impact on cancer screening, including that during the COVID-19 pandemic, remains unclear. Methods We used linked administrative data (2018–23) to examine the associations between these models and colorectal, cervical, and breast cancer screening rates. Fractional probit regression models, adjusting for physician and patient characteristics, estimated the effects of each payment model relative to the BFFS. Stratified analyses explored heterogeneity by physician sex, age, practice size, rurality, and socioeconomic deprivation. Results Compared with the BFFS model, the blended capitation models were associated with higher screening rates, although initial differences were modest. By 2022, nonteam and team capitation models had colorectal screening rates 3.0% and 3.6% higher, respectively, than those of the BFFS. Similar but smaller increases were observed for cervical and breast cancer screening. These advantages persisted through COVID-19 disruptions and were most pronounced among physicians serving rural or socioeconomically disadvantaged populations. Stratified analyses indicated that female, younger, and higher-volume physicians performed better in capitation-based models. Conclusions Blended capitation arrangements, especially those integrating interprofessional teams, appear more effective than the BFFS in delivering preventive cancer screening. Strengthening team-based primary care and targeted incentives could bolster preventable cancer screening rates in the population, even under pandemic-related challenges. These findings can inform policy decisions aimed at improving population health through optimized primary care provisions.

Chemotherapy use in ovarian cancer patients diagnosed 2012–2017 in Australia, Canada, Norway and the UK: An International Cancer Benchmarking Partnership (ICBP) population-based study

To describe use of chemotherapy in patients with ovarian cancer in national or sub-national populations of Australia, Canada, Norway and the UK. Linked population-based data sources were used to describe use and time to chemotherapy initiation in ovarian cancer patients diagnosed in study periods during 2012-2017. Random-effects meta-analysis characterised the size of interjurisdictional variation. Among 39,879 patients, chemotherapy use ranged from 49 % (Wales) to 75 % (Manitoba). Across jurisdictions, chemotherapy use was higher in advanced disease (79 %, 95 %CI: 74 %-83 %), and lower for stages 1-2 or localised/regional disease (54 %, 95 %CI: 48 %-60 %). Within jurisdictions, chemotherapy use was similar in patients aged 15-64 and 65-74 and then decreased sharply with increasing age. There was large interjurisdictional variation in chemotherapy use in patients aged 85-99 years with advanced disease, being, for example, 23 % (95 %CI: 20 %-25 %) in England and 61 % (95 %CI: 51 %-70 %) in Ontario. However, jurisdictions with the highest chemotherapy use in recorded advanced stage, including Ontario, tended to have higher percentage of missing stage information. Overall, time from diagnosis to chemotherapy initiation was shorter in New South Wales and Victoria and longer in Scotland and Wales. In patients with advanced disease, interjurisdictional variation in time-to-treatment was limited. Even within the same age groups and stage strata, use of chemotherapy varied substantially between jurisdictions during the mid-2010s. Future work should examine use of surgery in combination with chemotherapy. The reasons for the international variation in chemotherapy use and its contribution to international variation in survival should be established.