Incentive payments to British Columbia primary care physicians for chronic disease management: What is the effect on patient care?

Primary care is considered to be the foundation of the healthcare system. The province of BC offers incentive payments to encourage physicians to offer comprehensive primary care to their patients. There is now almost $100 million per year spent on these payments. Despite this large investment, there has not yet been a rigorous evaluation of their effect on either how physicians practice or whether patients benefit. This project will conduct such an evaluation. Our main question of interest is "what effect have Chronic Care Annual Bonus and Complex Care Initiative payments had on: continuity of care; hospitalization rates; total cost per patient (GP, specialist, diagnostic, hospital and pharmacy); and disease-specific quality indicators (for chronic disease incentives) among patients with qualifying chronic conditions"? In addition, we will look at the characteristics of physicians who did and did not bill incentives, the patients for whom incentives were billed and the how many people are now diagnosed with the qualifying chronic conditions. This study will use existing data for the whole population of British Columbia. Data will include information on physician payments, hospitalizations and prescription drug use. All data will be anonymous so it will not be possible to identify individual physicians or individual patients. The existing research literature does not tell us for certain what effect incentive payments have on patient care. BC is in a unique position to add to this literature because the province started incentive payments without at the same time changing the service delivery model, for example by encouraging the formation of group or multi-specialty practices. This research will provide much needed evidence to policy-makers about the intended and unintended consequences of these programs relative to their cost.