TORONTO, DECEMBER 11,
2017 — A payment
incentive introduced in 2011 to encourage psychiatrists to provide follow-up to
patients after a psychiatric hospitalization discharge or to those with a recent
suicide attempt did not increase access to care, according to a new study by
researchers at the Institute for
Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH).
In 2011, the provincial government introduced three incentive payments
for psychiatrists to see new patients within 30 days after discharge from a
psychiatric hospital and for six months following a suicide attempt. The
incentives included a 15 per cent premium for providing care within 30 days
after discharge from a psychiatric hospital, a 15 per cent premium for care
during the six months after a suicide attempt and a $200 annual fee for each
patient who receives follow-up care within a month.
“We know that not enough
patients have been receiving timely follow-up care after a psychiatric
hospitalization or suicide attempt. We also know that these are high risk times
for patients, and timely follow-up likely reduces these risks. However, our
study showed that financial incentives did not increase access to psychiatrists
at these critical times,” says Dr. Paul Kurdyak, co-author of the study,
scientist at ICES and at CAMH.
The study published today in CMAJ is one of the first to examine payment incentives in mental health services or psychiatric
care rather than primary care.
The study included
nearly 2,000 psychiatrists who were followed for more than 5 years from 2009 to
2014. The study also captured 304,574 patients aged 16 and older with a
psychiatric hospitalization discharge, and 78,375 people who had attempted
suicide. After the incentive payments were introduced, 40 per cent of patients
saw a psychiatrist for an incentivized visit in the six months following a
suicide attempt, and 26 per cent saw a psychiatrist for an incentivized visit
in the 30 days following discharge.
“As it stands, the
provincial investment in these incentive payments, while well-intentioned, has
not resulted in improved access to psychiatrists,” says Dr. David Rudoler, lead
author of the study and scientist at CAMH and the University of Toronto.
The researchers add that there are various reasons why the
incentives may not have worked including that the incentive ($30) may not have
been high enough to motivate behaviour. For psychiatrists who have reached a
certain pay level, such as those in urban areas, there is no behavioural
incentive to take on new patients for additional income. The researchers also
suggest that some psychiatrists may not have known about the incentive.
Payment Incentives for Community-Based Psychiatric Care in Ontario,Canada was published today in the CMAJ.
Author block: David
Rudoler, Claire de Oliveira, Joyce Cheng, Paul Kurdyak.
The Institute for Clinical Evaluative
Sciences (ICES) is an independent, non-profit organization that uses
population-based health information to produce knowledge on a broad range of
health care issues. Our unbiased evidence provides measures of health system
performance, a clearer understanding of the shifting health care needs of
Ontarians, and a stimulus for discussion of practical solutions to optimize
scarce resources. ICES knowledge is highly regarded in Canada and abroad, and
is widely used by government, hospitals, planners, and practitioners to make
decisions about care delivery and to develop policy. For the latest
ICES news, follow us on Twitter: @ICESOntario
The Centre for Addiction and Mental Health (CAMH) is Canada's largest
mental health and addiction teaching hospital and a world leading research
centre in this field. CAMH combines clinical care, research, education, policy
development and health promotion to help transform the lives of people affected
by mental illness and addiction. CAMH is fully affiliated with the University
of Toronto, and is a Pan American Health Organization/World Health Organization
Collaborating Centre. For more information, please visit camh.ca or follow
@CAMHnews on Twitter.
FOR FURTHER INFORMATION PLEASE CONTACT:
Media Advisor, ICES
(o) 416-480-4780 or (c) 647-406-5996
Media Relations, CAMH