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The impact of team-based primary care on health care services utilization and costs: Quebec’s family medicine groups

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Strumpf, Erin, Ammi, Mehdi, Diop, Mamadou, Fiset-Laniel, Julie, Tousignant, Pierre·2017·Journal of Health Economics
DOI 10.1016/j.jhealeco.2017.06.009
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Abstract

We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients' health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation.

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  • This pattern may also be consistent with an episode of illness, which could have accelerated attachment through the centralized waiting lists' prioritization process and would explain increase in utilization.

    “This pattern may also be consistent with an episode of illness, which could have accelerated attachment through the centralized waiting lists’ prioritization process and would explain increase in utilization [49, 96].”

    From Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada (2022) · cites this paper as [96]

    Section 3.1 discusses registration of elderly and chronically ill patients and notes that they use more health care services. Section 2.1 describes how patients joined family medicine groups. Neither passage addresses an episode of illness accelerating attachment through centralized waiting-list prioritization; searches for waiting lists and prioritization found no such passage in our copy. Page numbers were not available. (LLM, conf=0.75)

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Research works printed but not linked: 4

  1. Defelice, L.C., Bradford, W.D., 1997. Relative inefficiencies in production between solo and group practice physicians. Health Econ. 6 (5), 455-465.
  2. Ministère de la Santé et des Services sociaux, 2006. Devenir un GMF: Guide d'accompagnement -Le groupe de médecine de famille: un atout pour le patient et son médecin, les membres du groupe de soutien à l'implantation des groupes de médecine de famille., pp. 2014.
  3. J. Am. Board Fam. Pract. 16 (5), 412-422.
  4. Vérificateur général du Québec, 2015. Vérification de l'optimisation des ressources. Rapport du Vérificateur général du Québec à l'Assemblée nationale pour l'année., pp. 2015-2016.

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Authors
Strumpf, E., Ammi, M., Diop, M., Fiset-Laniel, J., & Tousignant, P.
Affiliations
  • Santé Québec Centre-Sud-de-l’Île-de-Montréal – Universitaire (CA)
  • Carleton University (CA)
Corresponding author
Strumpf, Erin
ORCID
Venue
Journal of Health Economics
Publisher
Elsevier BV
Published
2017-09
Volume
55
Pages
76-94
ISSN
0167-6296 (ISSN-L)
DOI
10.1016/j.jhealeco.2017.06.009
OpenAlex
W3121432686
Cited by
82
References
59
Citations by year
2026: 8 · 2025: 10 · 2024: 5 · 2023: 15 · 2022: 13 · 2021: 13 · 2020: 11 · 2019: 5 · 2018: 1 · 2017: 1
FWCI
4.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Health Economics (publishedVersion, cc-by-nc-nd)
  • SSRN Electronic Journal (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Carleton University's Institutional Repository (MacOdrum Library, Carleton University) (submittedVersion, other-oa)
Funders
  • Institut National de Santé Publique du Québec
  • Ministère de la Santé et des Services sociaux
  • Ministère de la Santé
  • Canadian Institutes of Health Research (123278_1, 123278, MOP 93546)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
team-based primary care, family medicine groups, health care utilization, health care costs, outpatient visits, specialist visits, elderly patients, chronic disease patients, multidisciplinary team, extended hours, Quebec
MeSH terms
Adolescent, Adult, Aged, Child, Child, Preschool, Delivery of Health Care, Family Practice, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Patient Care Team, Primary Health Care, Quebec, Health Care Costs, Young Adult

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