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Production of physician services under fee-for-service and blended fee-for-service: evidence from Ontario, Canada

Somé NH, Devlin RA, Mehta N, Zaric G, Li L, Shariff SZ, Belhadji B, Thind A, Garg AX, Sarma S. Health Econ. 2019; 28(12):1418-34. Epub 2019 Sep 15. DOI: 10.1002/hec.3951.

We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003–2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after‐hours services. A two‐stage estimation strategy teases out the impact of switching from FFS to FHG on service production. We account for the selection into FHG using a propensity score matching model, and then we use panel‐data regression models to account for observed and unobserved heterogeneity. Our results reveal that switching from FFS to FHG increases comprehensive care, after‐hours, and nonincentivized services by 3%, 15%, and 4% per annum. We also find that blended FFS physicians provide more services by working additional total days as well as the number of days during holidays and weekends. Our results are robust to a variety of specifications and alternative matching methods. We conclude that switching from FFS to blended FFS improves patients' access to after‐hours care, but the incentive to nudge service production at the intensive margin is somewhat limited.