Cap­i­ta­tion isn’t nec­es­sar­ily best

Re: One in six On­tar­i­ans left be­hind in health re­forms (Jan. 14)

The Hamilton Spectator - - OPINION -

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

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