The effect of enrolment policies on patient affiliation to a family physician
A quasi-experimental evaluation in Canada
Bibliographic Data
| ID | 21467772 |
|---|---|
| Authors | Caroline King (0000-0001-7100-4111, Institut National d'Excellence en Santé et en Services Sociaux), Real Lavergne (0000-0002-4205-4600), M Ruth Lavergne (Dalhousie University), Kimberlyn Mcgrail (0000-0002-9349-1915, University of British Columbia), Erin Strumpf (0000-0002-7348-8663, McGill University, corresponding author) |
| Year | 2025 |
| Volume | 156 |
| Pages | 105313 |
| Publication date | 2025-06-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy (JOURNAL) |
| Journal identifiers | ISSN: 0168-8510 • E-ISSN: 1872-6054 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.healthpol.2025.105313 |
| PMID | 40222056 |
| OpenAlex | W4409173101 |
| Language | EN |
| References cited | 33 |
Patient enrolment with a source of primary care should support continuity of care. • The impact of enrolment policies on affiliation is an important intermediate outcome. • Our Reporting a Regular Medical Doctor index adds the patient view on affiliation. • Quebec enrolment policies did not improve three measures of affiliation. • Enrolment alone is insufficient to increase affiliation, a key input to continuity. Affiliation, defined as having a usual source of care, revealed by patterns of repeated interactions between the patient and a clinician over time, can influence patients’ care experience, continuity of care and health outcomes. Many jurisdictions implement primary care enrolment policies, with the motivation to increase affiliation and thereby improve downstream patient outcomes. However, there is little evidence on the impacts of these policies on patient-physician affiliation. Using health administrative data, we evaluated the population-level effects of two policies that encourage primary care enrolment on affiliation in Quebec, Canada. We used quasi-experimental study designs (difference-in-difference and interrupted-time-series) to estimate changes in affiliation that could be attributed to the introduction of these policies. The 2003 policy targeted the enrolment of elderly and/or chronically ill patients, whereas the 2009 policy targeted the general population. We used three measures of patient-physician affiliation: dichotomous and continuous usual provider continuity, and the Reporting a Regular Medical Doctor (RRMD) index. Our analyses for both policies did not yield substantively important changes in our outcomes at the population level. Our effect estimates for both policies were stable under several robustness checks specific to each method. Our results suggest that policies that encourage enrolment do not, on their own, have an impact on patient-physician affiliation. If enrolment policies are not sufficient to increase patient-physician affiliation, further research is needed to understand the factors that influence both affiliation and other downstream outcomes
Family medicine · Global Health Workforce Issues · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes · Psychology · Gerontology
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Fixed effects analysis of repeated measures data
The Estimation of Causal Effects by Difference-in-Difference Methods
Interrupted time series regression for the evaluation of public health interventions
How Much Should We Trust Differences-In-Differences Estimates?
Inference with Difference-in-Differences and Other Panel Data
Receipt of Preventive Care Among Adults
The Effects of Having a Regular Doctor on Access to Primary Care
Lack of Ethnic Disparities in Adult Immunization Rates Among Underserved Older Patients in an Urban Public Health System
An Equivalence Approach to Balance and Placebo Tests
Recent Developments in the Econometrics of Program Evaluation
| Highly cited | No |
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