Browsing by Author "Quinn, Amity E."

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    A comparison between alternative primary care physician payment models: A systematic review and policy analysis
    (2020-09-24) Souri, Sepideh; McBrien, Kerry Alison; Chuck, Anderson W.; Manns, Braden J.; Quinn, Amity E.
    Objective: Alternative models of primary care physician payment are being considered by policy-makers as a potential way to contain healthcare expenditures. The purpose of this thesis was to synthesize the evidence for alternative primary care physician payment models on quality and economic outcomes worldwide and to make recommendations with respect to payment models that may improve chronic disease management in Canada. Methods: We first conducted a systematic review, searching selected databases from inception to October 2018, for studies that compared primary care physician payment models. There were no restrictions on language, country, or publication date, however studies were restricted to specific study designs (randomized controlled trial, controlled cohort and interrupted time series). A gray literature search was also conducted. The outcomes considered were quality and access to care, patient and physician satisfaction, clinical outcomes, healthcare utilization and costs. Thirteen studies were selected for synthesis, comparing fee-for-service, capitation, incentive payments, and mixed models. We then identified primary care payment methods currently used in Canada through an environmental scan. We applied evidence from the systematic review to evaluate the impact of the three most promising models on quality, utilization, cost, and implementation feasibility, and made a recommendation. Conclusion: Primary care payment models have moved toward incentive payments and mixed models in recent years, and mixed models have promising effects on cost and utilization overall and for managing chronic disease in primary care in Canada. Incentive payments show low sustainability in quality improvements, and a gap in incentivized and non-incentivized aspects of care. Mixed models have been introduced in primary care in Canada. Based on current evidence, the recommended payment model for Canadian primary care physicians that is most likely to optimize chronic disease management is blended capitation. Future studies should focus on long-term quality improvements and improving the quality of non-incentivized activities in incentive models. Further study would help to elucidate the potential benefit of mixed models, in particular their effect on patient-oriented aspects of care: access, continuity, and quality. More studies are needed to understand how blended capitation payment models affect costs and utilization.
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    “We’re sinking”: a qualitative interview-based study on stakeholder perceptions of structural and process limitations to the Canadian healthcare system
    (2024-04-25) Parsons Leigh, Jeanna; Moss, Stephana J.; Mizen, Sara J.; Sriskandarajah, Cynthia; FitzGerald, Emily A.; Quinn, Amity E.; Clement, Fiona; Farkas, Brenlea; Dodds, Alexandra; Columbus, Melanie; Stelfox, Henry T.
    Abstract Background Despite longstanding efforts and calls for reform, Canada’s incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully. Methods We conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants’ perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian’s Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods. Results The data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care). Conclusion Canadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.