Periodic health visits by primary care practice model, a population-based study using health administrative data

• Published in: BMC family practice Vol. 20; no. 1; p. 42
• Main Authors: Saunders, Natasha Ruth, Guan, Jun, Fu, Longdi, Guo, Helen, Wang, Xuesong, Guttmann, Astrid
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.03.2019; BioMed Central; BMC
• Subjects: Adult; Adults; Aged; Analysis; Capitation Fee; Comorbidity; Databases, Factual; Delivery of Health Care - organization & administration; Evidence-based medicine; Family medicine; Fee-for-service; Fee-for-Service Plans; Female; Health care policy; Health care reform; Health insurance; Health insurance industry; Humans; Male; Management; Medical care; Medical examination; Medical practice; Medium term notes; Middle Aged; Mortality; Ontario; Patient Care Team; Pay for performance; Periodic health visit; Physician enrollment; Population-based studies; Preventive Health Services - statistics & numerical data; Primary Health Care - organization & administration; Young Adult; Ontario; Ontario Canada; Canada; Physician enrollment; Periodic health visit; Fee-for-service
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/s12875-019-0927-6

The general health check, which includes the periodic health visit and annual physical exam, is not recommended to maintain the health of asymptomatic adults with no risk factors. Different funding mechanisms for primary care may be associated with the provision of service delivery according to recommended guidelines. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model. Population-based cross-sectional study using linked health and administrative datasets in Ontario, Canada, where most residents are insured for physician services through Ontario's single payer, provincially funded Ontario Health Insurance Plan. Participants included all living adults (> 19 years) in Ontario on January 1st, 2014, eligible for the Ontario Health Insurance Plan. Primary care enrollment model was the main exposure and included traditional fee-for-service, enhanced fee-for-service, capitation, team-based care, other (including salaried), and unenrolled. The main outcome measure was receipt of a periodic health visit during 2014. Age-sex standardized rates of periodic health visits performed during the one-year study period were analyzed by number of comorbid conditions. Of 10,712,804 adults in Ontario, 2,350,386 (21.9%) had a periodic health visit in 2014. The age-sex standardized rate was 6.1% (95% confidence interval [CI] 6.0, 6.1%) for healthy individuals. In the traditional fee-for-service model, the periodic health visit was performed for 55.3% (95% CI 54.4, 56.3%) of healthy individuals versus 10.2% (95% CI 10.0, 10.3%) in team-based care. Periodic health visit rates varied by primary care provider models. Traditional and enhanced fee-for-service models had higher rates across all comorbidity groups. Patients whose primary care physicians are funded exclusively through fee-for-service had the highest rates of periodic health visits in healthy individuals. Primary care reform initiatives must consider the influence of remuneration on providing evidence-based primary care.