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Payment incentives for community-based psychiatric care in Ontario, Canada

Rudoler D, de Oliveira C, Cheng J, Kurdyak P. CMAJ. 2017; 189(49):E1509-16. Epub 2017 Dec 11.

Background — In September 2011, the Government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients following psychiatric hospitalization discharge, or to those with a recent suicide attempt. We evaluated whether these incentives impacted psychiatric supply behaviour and access to care.

Methods — We used administrative data to capture monthly observations on all psychiatrists who practiced in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to evaluate whether the incentives impacted the quantity of eligible outpatient services delivered, and the likelihood of receiving follow-up care.

Results — Among 1,921 psychiatrists evaluated, the implementation of the incentive payments was not associated with increased follow-up visits provided post-psychiatric hospitalization discharge (0.0099; 95% Confidence Interval (CI) -0.0989, 0.1206), or post-suicide attempt (-0.0910; 95% CI -0.1885, 0.0026). There was also no change in the likelihood that patients received follow-up care post discharge (-0.0002; 95% Confidence Interval -0.0010, 0.0006) or post suicide attempt (0.0002; Confidence Interval -0.0013, 0.0012).

Interpretation — Our results suggest that the implementation of the incentives did not increase access to follow-up care for patients following psychiatric hospitalization discharge or following a suicide attempt, and the incentives had no effect on psychiatrist supply behaviour. Further research to guide design and implementation of more effective incentives is warranted.

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