Featured Research

from universities, journals, and other organizations

Diabetes care depends on how your doctor is paid

Date:
June 5, 2014
Source:
St. Michael's Hospital
Summary:
From 2006 to 2008, nearly 75 percent of Ontarians with diabetes did not receive all of the tests recommended to properly monitor their disease. How their doctor was paid was one of the factors determining the care they received, according to a study.

From 2006 to 2008, nearly 75 per cent of Ontarians with diabetes did not receive all of the tests recommended to properly monitor their disease. How their doctor was paid was one of the factors determining the care they received, according to a study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES).

Related Articles


The study, published in the Canadian Journal of Diabetes, found that patients who were not actively enrolled with a family doctor were least likely to receive optimum diabetes care. The researchers found that more than 200,000 Ontarians with diabetes were not formally enrolled with a family doctor -- either because they didn't have a family doctor or because their doctor practiced in a traditional fee-for-service model.

Over the last decade, in an effort to improve Ontarians' access to family doctors and provide more timely care, the province began implementing different payment models for physicians. Traditionally, family doctors in Ontario were paid a fee for each service they provided, billing OHIP for each patient visit. In newer models, doctors' pay is more complicated -- a combination of fee-for-service payment and a lump sum payment for every patient enrolled in their practice. Many doctors now receive the majority of their pay through a lump sum payment per patient, called capitation. All new models emphasize formally enrolling patients with a family doctor or group of doctors.

"When it comes to diabetes, not all Ontarians are getting equal care," said lead author Dr. Tara Kiran, a family physician and an associate scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital. "Ontarians whose doctors are paid a lump sum per patient are more likely to get the diabetes tests they need. Lump sum funding gives family physicians the flexibility to spend more time with complex patients, collaborate with other professionals, and integrate email and phone calls into their practices."

Ontario has transitioned 40 per cent of its family physicians to capitation models in the hopes of improving quality of care and reducing costs. Capitation models require evening and weekend clinics, formally enrol patients, and have incentive payments to physicians for immunizations, cancer screening, smoking cessation and management of chronic diseases such as diabetes. The still-existing and traditional physician payment model pays doctors a fee for each service they provide and does not require evening and weekend clinics or include the additional step of formal enrolment.

Because the study looked at one point in time, more research is needed to see if new payment models caused improvements in care over time or if higher-performing physicians were the doctors to join the newer payment models.

The Canadian Diabetes Association's clinical practice guidelines recommend that over the course of two years patients with diabetes undergo four HbA1C laboratory tests to measure blood sugar control, two cholesterol tests and a retinal eye exam. Researchers defined optimum diabetes care as receiving all three types of testing at the recommended intervals.

Researchers analyzed data for 757,928 people with Type 1 and Type 2 diabetes who were aged 40 or older -- approximately 12 per cent of Ontario's population.

Between 2006 and 2008

  • Sixty-eight per cent of Ontarians with diabetes received one or more retinal eye exams
  • Seventy-eight per cent of Ontarians with diabetes underwent at least one HbA1C laboratory test to measure blood sugar control and 37 percent had four or more tests, as recommended
  • Eighty per cent of Ontarians with diabetes received at least one cholesterol test and 59 per cent received the optimal two cholesterol tests.

"Limited access to good primary care can lead to poor management of chronic diseases, fragmented care through walk-in clinics, and overburdened emergency departments," said Dr. Rick Glazier, a senior scientist at ICES and research director in the Department of Family and Community Medicine of St. Michael's Hospital.

The authors suggest that intensifying patient outreach, improving physician education, encouraging enrolment, and making efforts to remove barriers to care may reduce this care gap.


Story Source:

The above story is based on materials provided by St. Michael's Hospital. The original article was written by Geoff Koehler. Note: Materials may be edited for content and length.


Cite This Page:

St. Michael's Hospital. "Diabetes care depends on how your doctor is paid." ScienceDaily. ScienceDaily, 5 June 2014. <www.sciencedaily.com/releases/2014/06/140605141557.htm>.
St. Michael's Hospital. (2014, June 5). Diabetes care depends on how your doctor is paid. ScienceDaily. Retrieved March 31, 2015 from www.sciencedaily.com/releases/2014/06/140605141557.htm
St. Michael's Hospital. "Diabetes care depends on how your doctor is paid." ScienceDaily. www.sciencedaily.com/releases/2014/06/140605141557.htm (accessed March 31, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Tuesday, March 31, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Solitair Device Aims to Takes Guesswork out of Sun Safety

Solitair Device Aims to Takes Guesswork out of Sun Safety

Reuters - Innovations Video Online (Mar. 31, 2015) — The Solitair device aims to take the confusion out of how much sunlight we should expose our skin to. Small enough to be worn as a tie or hair clip, it monitors the user&apos;s sun exposure by taking into account their skin pigment, location and schedule. Matthew Stock reports. Video provided by Reuters
Powered by NewsLook.com
Soda, Salt and Sugar: The Next Generation of Taxes

Soda, Salt and Sugar: The Next Generation of Taxes

Washington Post (Mar. 30, 2015) — Denisa Livingston, a health advocate for the Dinι Community Advocacy Alliance, and the Post&apos;s Abby Phillip discuss efforts around the country to make unhealthy food choices hurt your wallet as much as your waistline. Video provided by Washington Post
Powered by NewsLook.com
UnitedHealth Buys Catamaran

UnitedHealth Buys Catamaran

Reuters - Business Video Online (Mar. 30, 2015) — The $12.8 billion merger will combine the U.S.&apos; third and fourth largest pharmacy benefit managers. Analysts say smaller PBMs could also merge. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
S. Leone in New Anti-Ebola Lockdown

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015) — Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins