Is the Road to Mental Health Paved With Good Incentives? Estimating the Population Impact of Physician Incentives on Mental Health Care Using Linked Administrative Data

Bibliographic Data

ID9101125
AuthorsJoseph H Puyat (0000-0003-3710-5773, University of British Columbia, corresponding author), Arminée Kazanjian (0000-0001-8702-1522, University of British Columbia, corresponding author), Hubert Wong (0000-0001-8840-4509, University of British Columbia, corresponding author), Elliot M Goldner (Simon Fraser University)
Year2017
Volume55
Issue2
Pages182-190
Publication date2017-02-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000639
PMID27632766
OpenAlexW2520812524
LanguageEN
Citations received4
References cited22

OBJECTIVES: The use of physician incentives to improve health care, in general, has been extensively studied but its value in mental health care has rarely been demonstrated. In this study the population-level impact of physician incentives on mental health care was estimated using indicators for receipt of counseling/psychotherapy (CP); antidepressant therapy (AT); minimally adequate counseling/psychotherapy; and minimally adequate antidepressant therapy. The incentives' impacts on overall continuity of care and of mental health care were also examined. MATERIALS AND METHODS: Monthly cohorts of individuals diagnosed with major depression were identified between January 2005 and December 2012 and their use of mental health services tracked for 12 months following initial diagnosis. Linked health administrative data were used to ascertain cases and measure health service use. Pre-post changes associated with the introduction of physician incentives were estimated using segmented regression analyses, after adjusting for seasonal variation. RESULTS: Physician incentives reversed the downward and upward trends in CP and AT. Five years postintervention, the estimated impacts in percentage points for CP, AT, minimally adequate counseling/psychotherapy, and minimally adequate antidepressant therapy were +3.28 [95% confidence interval (CI), 2.05-4.52], -4.47 (95% CI, -6.06 to -2.87), +1.77 (95% CI, 0.94-2.59), and -2.24 (95% CI, -4.04 to -0.45). Postintervention, the downward trends in continuity of care failed to reverse, but were disrupted, netting estimated impacts of +7.53 (95% CI, 4.54-10.53) and +4.37 (95% CI, 2.64-6.09) for continuity of care and of mental health care. CONCLUSIONS: The impact of physician incentives on mental health care was modest at best. Other policy interventions are needed to close existing gaps in mental health care

Confidence interval · Environmental health · Family medicine · Health care · Incentive · Mental health · Population · Psychiatry · Emergency Medicine · Healthcare Policy and Management · Internal Medicine · Medicine · Mental Health Treatment and Access · Primary Care and Health Outcomes

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