Go to content

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


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.



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

View Source