Incentive payments to physicians may reduce non-urgent ER visits

New research has shown that providing primary care physicians with incentives to see patients after hours may result in fewer visits to the emergency department for non-urgent issues.

“We found that the introduction of the after-hours premium reduced some less-urgent visits, suggesting that some emergency department visits can be avoided through improved access to primary care,” wrote Sisira Sarma, professor at Schulich Medicine & Dentistry who studies the economics of primary health care, economic evaluation of health interventions, analysis of health care costs and health outcomes.

Western professor Sarma Sisira

Western professor Sarma Sisira

In 2003, to improve access to primary care outside of the regular working-hours, the Ontario government introduced an after-hours financial incentive for family physicians to provide specific services after regular clinic hours.

The study, published in CMAJ (Canadian Medical Association Journal), looked at the impact of these incentives during two periods: 2002 to 2006 after incentive payments were first introduced and later increased to 15 per cent from 10 per cent; and 2005 to 2016, when payments increased to 30 per cent.

Researchers found that the after-hours premium was associated with a reduction in less-urgent visits to the emergency department by 1.26 per 1000 patients per month and was the difference was even more pronounced after hours than during regular hours.

Sarma said research approaches like this are critically important to evaluate the real-world impact of policy changes and financial incentives on health care outcomes.

“Providing targeted incentives on the supply side is a useful policy option to improve access to primary care services and reduce unnecessary visits to the emergency department,” said Sarma. “Those less-urgent services that can be provided in primary care setting at a lower cost may reduce Emergency Department overcrowding as well as provide health-system cost savings.”

And as COVID-19 continues to put strain on our health care system, this research takes on extra importance.

“In the face of the pandemic, this research and other research focusing on improving access to primary care could potentially reduce the burden on the hospital system and divert lower-risk patients to alternative areas of care,” said Michael Hong, a PhD Candidate supervised by Sarma who is the first author of this research.

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