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Primary Health Care System

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The effectiveness and cost of financial incentives for cancer screening among primary care physicians in Ontario"
Presenters: Tara Kiran, Staff Physician, Family & Community Medicine, St. Michael’s Hospital, Associate Scientist, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, New Investigator, Family & Community Medicine, University of Toronto and Richard Glazier, Scientist, Institute for Clinical Evaluative Sciences, Scientist, Centre for Research on Inner City Health, St. Michael’s Hospital, Professor, Family and Community Medicine, University of Toronto and St. Michael’s Hospital
May 17, 2012

Abstract: Background: We assessed the use and cost of incentives introduced over the past decade for primary care physicians in Ontario, Canada in relation to uptake of cervical, breast, and colorectal cancer screening.

Methods:We used available administrative data to do a cross-sectional analysis of screening uptake among 3,056,337, 1,600,645 and 3,713,971 patients eligible for cervical, breast, and colorectal cancer, respectively, and use of cancer screening incentive codes among 5946 eligible physicians in 2009-10. We did a longitudinal analysis to assess screening uptake and cost in each fiscal year from 2000-01 to 2009-10 and a regression analysis to compare the rate of change in uptake before versus after introduction of the incentives.

Results: There was minimal increase in cervical and breast cancer screening over time. There was a gradual increase in colorectal cancer screening from 18% in 2000-01 to 51% in 2009-10 but the rate in improvement was similar before and after the incentive was introduced. Low-income individuals and new residents were less likely to receive cancer screening and these disparities increased over time for colorectal cancer screening. Physicians who were eligible for the incentives had higher screening rates historically than those not eligible. In 2009-10, $8.4 million, $9.4 million, and $18.2 million was spent on cervical, breast, and colorectal cancer screening incentives, respectively.

Interpretation: Physician financial incentives had limited impact on cancer screening rates despite substantial related incentive costs. Incentives were directed at physicians who historically had higher screening rates.


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