Financial incentives to psychiatrists did not increase follow-up care for patients after a psychiatric hospitalization discharge or suicide attempt

11/12/2017

A payment incentive introduced in 2011 to encourage psychiatrists to provide follow-up to patients after a psychiatric hospitalization discharge or to those with a recent suicide attempt did not increase access to care, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH).

In 2011, the provincial government introduced three incentive payments for psychiatrists to see new patients within 30 days after discharge from a psychiatric hospital and for six months following a suicide attempt. The incentives included a 15 per cent premium for providing care within 30 days after discharge from a psychiatric hospital, a 15 per cent premium for care during the six months after a suicide attempt and a $200 annual fee for each patient who receives follow-up care within a month.

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“We know that not enough patients have been receiving timely follow-up care after a psychiatric hospitalization or suicide attempt. We also know that these are high risk times for patients, and timely follow-up likely reduces these risks. However, our study showed that financial incentives did not increase access to psychiatrists at these critical times,” says Dr. Paul Kurdyak, co-author of the study, scientist at ICES and at CAMH.

The study published today in CMAJ is one of the first to examine payment incentives in mental health services or psychiatric care rather than primary care.

The study included nearly 2,000 psychiatrists who were followed for more than five years from 2009 to 2014. The study also captured 304, 574 patients aged 16 and older with a psychiatric hospitalization discharge, and 78, 375 people who had attempted suicide. After the incentive payments were introduced, 40 per cent of patients saw a psychiatrist for an incentivized visit in the six months following a suicide attempt, and 26 per cent saw a psychiatrist for an incentivized visit in the 30 days following discharge.

“As it stands, the provincial investment in these incentive payments, while well-intentioned, has not resulted in improved access to psychiatrists,” says Dr. David Rudoler, lead author of the study and scientist at CAMH and the University of Toronto.

The researchers add that there are various reasons why the incentives may not have worked including that the incentive ($30) may not have been high enough to motivate behaviour. For psychiatrists who have reached a certain pay level, such as those in urban areas, there is no behavioural incentive to take on new patients for additional income. The researchers also suggest that some psychiatrists may not have known about the incentive.

“Payment incentives for community-based psychiatric care in Ontario, Canada,” was published today in the CMAJ.

Author block: David Rudoler, Claire de Oliveira, Joyce Cheng, Paul Kurdyak.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.