Mental Health Services Provision in Primary Care and Emergency Department Settings: Analysis of Blended Fee-for-Service and Blended Capitation Models in Ontario, Canada

We examined the quantity of mental health services provided in Ontario ’s blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data from 2007 to 2016. We accounted for the differences between those who switched to blended capitation and non-switchers in the baseline using propensity score weighted fixed-effects regressions to compare remuneration models. We found that switching from blended fee-for-service to blended capitation was associated wit h a 14% decrease (95% CI 12–14%) in the number of mental health services and an 18% decrease (95% CI 15–20%) in the corresponding value of services. This result was driven by the decrease in services during regular-hours. During after-hours, the number of services increased by 20% (95% CI 10–3 2%) and the corresponding value increased by 35% (95% CI 17–54%). Switching was associated with a 4% (95% CI 1–8%) decrease in emergency department visits for mental health reasons. Blended capitation reduced provision of mental health services without increasing emergency department visits, sug gesting potential efficiency gain in the blended capitation model in Ontario.
Source: Administration and Policy in Mental Health and Mental Health Services Research - Category: Psychiatry Source Type: research