Who gets a family physician through centralized waiting lists?
Open accessAbstract
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.
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Centralized waiting lists are effective to increase attachment.
“Previous research suggests that centralized waiting lists are effective to increase attachment [44].”
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 [44]
The Abstract Results and Conclusion (page unavailable) report increased enrolment with family physicians through Quebec’s centralized waiting lists. But the increase followed changes to financial incentives, and many patients enrolled through the lists had not first registered on or waited through them. The paper therefore supports increased enrolment under that combined policy, not the broader claim that centralized waiting lists themselves are effective at increasing attachment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrior research has found evidence that family physicians "cherry-pick" healthier patients for attachment, avoiding patients with more complex health needs.
“This is coherent with prior research that has found evidence that family physicians “cherry-pick” healthier patients for attachment, avoiding patients with more complex health needs (e.g. mental health problems, intellectual disability) [44, 46–49].”
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 [44]
The Abstract Conclusion and Discussion > Interpretation say physicians favoured enrolling healthier, non-vulnerable patients over those with greater health needs. The Discussion also reports longer waits for patients with mental health problems. Our copy does not identify intellectual disability as an example, so that part of the citing sentence is not supported by this source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe difference in non-vulnerable proportion is likely due to the time period included in the previous study during which centralized waiting lists policies were more conducive to cherry-picking by family physicians.
“This difference is likely due to the time period included in the previous study during which centralized waiting lists policies were more conducive to cherry-picking by family physicians [44].”
The proportion of non-vulnerable patients attached through centralized waiting lists in this study is slightly lower than reported in a previous study (about 70% non-vulnerable).
“This large proportion of healthy patients attached through the centralized waiting lists is slightly lower than reported in a previous study (about 70% non-vulnerable patients attached through centralized waiting lists) [44].”
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Cites
Contribution of Primary Care to Health Systems and Health
STARFIELD, B., SHI, L., & MACINKO, J. (2005) · The Milbank Quarterly · doi:10.1111/j.1468-0009.2005.00409.x · Cited by 5,507 · see citing works
Building on Values: The Future of Health Care in Canada
Wynne, M., & Armstrong, W. S. (2005) · Cited by 1,027 · see citing works
Prevalence of multimorbidity among adults seen in family practice
Fortin, M. (2005) · The Annals of Family Medicine · doi:10.1370/afm.272 · Cited by 987 · cited 1× · see citing works
“While the benefits of having a family physician are numerous for vulnerable clienteles [26-28], for others, such as those who are young and in good health, sustained contact with a physician has little measurable impact on their already good health status [29].”
BackgroundBuilding on Values: Report of the Commission on the Future of Health Care in Canada [Reports]
Romanow, R. J. (2002) · Cited by 427 · see citing works
Kringos, D. S., Boerma, W. G. W., van der Zee, J., et al. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.1242 · Cited by 351 · see citing works
The Effects of Having a Regular Doctor on Access to Primary Care
LAMBREW, J. M., DEFRIESE, G. H., CAREY, T. S., RICKETTS, T. C., & BIDDLE, A. K. (1996) · Medical Care · doi:10.1097/00005650-199602000-00006 · Cited by 274 · see citing works
Cheraghi‐Sohi, S., Hole, A. R., Mead, N., McDonald, R., Whalley, D., Bower, P., & Roland, M. O. (2008) · The Annals of Family Medicine · doi:10.1370/afm.816 · Cited by 262 · see citing works
Schoen, C., Osborn, R., Squires, D. A., & Doty, M. M. (2013) · Health Affairs · doi:10.1377/hlthaff.2013.0879 · Cited by 256 · see citing works
Glazier, R. H., Klein-Geltink, J., Kopp, A., & Sibley, L. M. (2009) · Canadian Medical Association Journal · doi:10.1503/cmaj.081316 · Cited by 203 · see citing works
Burns, L. R., & Muller, R. W. (2008) · Milbank Quarterly · doi:10.1111/j.1468-0009.2008.00527.x · Cited by 166 · see citing works
Impact of pay for performance on inequalities in health care: systematic review
Alshamsan, R., Majeed, A., Ashworth, M. J., Car, J., & Millett, C. J. (2010) · Journal of Health Services Research & Policy · doi:10.1258/jhsrp.2010.009113 · Cited by 104 · see citing works
It's about more than money: financial incentives and internal motivation
Marshall, M. (2005) · BMJ Quality & Safety · doi:10.1136/qshc.2004.013193 · Cited by 102 · see citing works
Does having regular care by a family physician improve preventive care?
(2001) · PubMed Central · Cited by 99 · see citing works
Caring for Medicare: Sustaining a Quality System
Kj, F. (2001) · Cited by 80 · see citing works
Building the Patient-Centered Medical Home in Ontario
Glazier, R. H. (2010) · JAMA · doi:10.1001/jama.2010.753 · Cited by 63 · see citing works
Breton, M., Lévesque, J., Pineault, R., et al. (2011) · Healthcare policy · doi:10.12927/hcpol.2011.22618 · Cited by 58 · see citing works
Self-citationEthical Physician Incentives — From Carrots and Sticks to Shared Purpose
Biller‐Andorno, N., & Lee, T. H.-Y. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1300373 · Cited by 53 · see citing works
Quebec’s Family Medicine Groups: Innovation and Compromise in the Reform of Front-Line Care
Pomey, M., Martin, E., & Forest, P. (2009) · Canadian Political Science Review · doi:10.24124/c677/2009193 · Cited by 41 · see citing works
Marshall, S. (2002) · A Nudge Too Far? A Nudge at All? On Paying People to Be Healthy · doi:10.12927/hcpap..16921 · Cited by 31 · see citing works
Pomey, M., Forest, P., Sanmartin, C., DeCoster, C., Clavel, N., Warren, E., Drew, M., & Noseworthy, T. (2013) · Implementation Science · doi:10.1186/1748-5908-8-61 · Cited by 28 · see citing works
Connecting orphan patients with family physicians: differences among Quebec's access registries.
Breton, M., Ricard, J., & Walter, N. (2012) · PubMed · Cited by 9 · see citing works
Self-citationImplementing Centralized Waiting Lists for Patients without a Family Physician in Quebec
Breton, M., Gagne, J., & Gankpe, F. (2014) · Health Reform Observer - Observatoire des Réformes de Santé · doi:10.13162/hro-ors.02.01.05 · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- [20]Régie de l'assurance maladie du Québec. [Press Release] Services de médecine de famille de prise en charge et de suivi de la clientèle. Québec; 2008.
- [24]Georges P Liste d’attente: des patients écartés de façon arbitraire 2013 Sun Media. Montreal Le Journal de Montréal
Cited by
Sorted by citations
Breton, M., Smithman, M. A., Brousselle, A., Loignon, C., Touati, N., Dubois, C.-A., Nour, K., Boivin, A., Berbiche, D., & Roberge, D. (2017) · BMC Family Practice · doi:10.1186/s12875-016-0573-1 · Cited by 80 · see citing works
Self-citationBreton, M., Smithman, M. A., Sasseville, M., Kreindler, S. A., Sutherland, J. M., Beauséjour, M., Green, M., Marshall, E. G., Jbilou, J., Shaw, J., et al. (2020) · Health Policy · doi:10.1016/j.healthpol.2020.05.023 · Cited by 30 · see citing works
Self-citationSmithman, M. A., Brousselle, A., Touati, N., Boivin, A., Nour, K., Dubois, C.-A., Loignon, C., Berbiche, D., & Breton, M. (2018) · International Journal for Equity in Health · doi:10.1186/s12939-018-0887-9 · Cited by 29 · see citing works
Self-citationSmithman, M. A., Haggerty, J., Gaboury, I., & Breton, M. (2022) · BMC Primary Care · doi:10.1186/s12875-022-01850-4 · Cited by 25 · see citing works
“It is possible that during early implementation, attachment policies mainly formalized pre-existing informal relationships between providers and patients, and may not have benefited patients without a regular provider or usual source of care [42, 44].”
BackgroundResultInfluentialSelf-citation
- Authors
- Breton, M., Brousselle, A., Boivin, A., Roberge, D., Pineault, R., & Berbiche, D.
- Affiliations
- Université de Sherbrooke (CA)
- Université de Montréal (CA)
- Hôpital Charles-Le Moyne (CA)
- Corresponding author
- Breton, Mylaine
- Venue
- BMC Family Practice
- Published
- 2015-02-05
- Volume
- 16
- Issue
- 1
- Pages
- 10-10
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC4328670
- OpenAlex
- W2027892605
- Cited by
- 30
- References
- 22
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 3 · 2020: 3 · 2018: 4 · 2017: 2
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UVic’s Research and Learning Repository (University of Victoria) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Fonds de Recherche du Québec - Santé
- 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
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Keywords
- financial incentives, vulnerable patients, primary care access, physician referral
- MeSH terms
- Family Practice, Health Services Accessibility, Humans, Longitudinal Studies, Motivation, Patients, Physicians, Family, Quebec, Referral and Consultation, Registries, Waiting Lists, Controlled Before-After Studies
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