Capitation isn’t necessarily best
Re: One in six Ontarians left behind in health reforms (Jan. 14)
Tara Kiran’s article seems to suggest that those doctors paid by a capitation payment scheme deliver better care (these would be Family Health Organizations) versus those in a fee-for-service model (like a Family Health Group). However, there is evidence to suggest that this may not be true.
Richard H. Glazier’s article, in the CMAJ (May 26, 2009) reviewed capitation vs. enhanced fee-for-service models and showed that those in a capitation model had patients with lower comorbidity (i.e. less sick patients), provided less after-hour care, and had more patients visiting the emergency room. Further, the capitation group enrolled fewer patients than the fee-for-service model. More recently, the Auditor General of Ontario (AGO) in 2016 notes that patients with non-urgent care used the emergency room at a cost of $62 million in 2014/ 2015, and $33 million of this figure was for patients enrolled in Family Health Organizations. Thus, there is concern that capitation-based practices are at least not superior to enhanced fee-for-service family practice, and are more expensive at the same time.
So, when Tara Kiran rightly raises concern for the most vulnerable and disadvantaged patients, it would be wise to remember our experience with capitation and that it was a model originally introduced by the government in 1980, and is now closed to new physicians. Dr A.B.L. Vas, Hamilton