Who gets a family physician through centralized waiting lists?

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dc.contributor.author Breton, Mylaine
dc.contributor.author Brousselle, Astrid
dc.contributor.author Boivin, Antoine
dc.contributor.author Roberge, Danièle
dc.contributor.author Pineault, Raynald
dc.contributor.author Berbiche, Djamal
dc.date.accessioned 2021-02-18T23:13:38Z
dc.date.available 2021-02-18T23:13:38Z
dc.date.copyright 2015 en_US
dc.date.issued 2015
dc.identifier.citation Breton, M., Brousselle, A., Boivin, A., Roberge, D., Pineault, R., & Berbiche, D. (2015). Who gets a family physician through centralized waiting lists? BMC Family Practice, 16(10), 1-11. https://doi.org/10.1186/s12875-014-0220-7. en_US
dc.identifier.uri https://doi.org/10.1186/s12875-014-0220-7
dc.identifier.uri http://hdl.handle.net/1828/12693
dc.description.abstract Background: North American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians’ enrolment of orphan patients through centralized waiting lists, the Guichet d’accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians’ after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled. Methods: A longitudinal quantitative analysis spanning a five-year period (2008–2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used. Results: The number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level. Conclusion: Centralized waiting lists linked to financial incentives increased the number of family physicians’ patient enrolments. However, although vulnerable patients were supposed to be given precedence, physicians favoured enrolment of healthier patients over those with greater health needs and higher assessed priority. These results suggest that introducing financial incentives without appropriate regulations may lead to opportunistic use of the incentive system with unintended policy consequences. en_US
dc.description.sponsorship This study was funded by the Fonds de Recherche du Québec - Santé (FRQS) and the Agence de la santé et des services sociaux de la Montérégie. AB is funded by a CIHR clinician-scientist award. en_US
dc.language.iso en en_US
dc.publisher BMC Family Practice en_US
dc.subject Payment en_US
dc.subject Incentives en_US
dc.subject Centralized waiting lists en_US
dc.subject Registry en_US
dc.subject Enrolment en_US
dc.subject Vulnerable patients en_US
dc.title Who gets a family physician through centralized waiting lists? en_US
dc.type Article en_US
dc.description.scholarlevel Faculty en_US
dc.description.reviewstatus Reviewed en_US

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