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.
