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Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early\u2010 to mid\u20102000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non\u2010incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two\u2010stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended\u2010fee\u2010for\u2010service (FFS), 1388 blended\u2010capitation models, and 1164 interprofessional team\u2010based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation\u2010based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended\u2010FFS\u2010based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team\u2010based practices.<\/jats:p>","DOI":"10.1002\/hec.4872","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T05:43:39Z","timestamp":1718862219000},"page":"2288-2305","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0382-2950","authenticated-orcid":false,"given":"Nibene Habib","family":"Som\u00e9","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics Western University  London Ontario Canada"},{"name":"ICES  Toronto Ontario Canada"},{"name":"Institute for Mental Health Policy Research Centre for Addiction and Mental Health  Toronto Ontario Canada"},{"name":"Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health  Toronto Ontario Canada"},{"name":"Institute of Health Policy Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1386-4700","authenticated-orcid":false,"given":"Rose Anne","family":"Devlin","sequence":"additional","affiliation":[{"name":"Department of Economics University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirav","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Economics Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9174-765X","authenticated-orcid":false,"given":"Sisira","family":"Sarma","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Western University  London Ontario Canada"},{"name":"ICES  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2011.05.016"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1071\/PY07043"},{"key":"e_1_2_9_4_1","volume-title":"2016 annual report","author":"Auditor General of Ontario","year":"2016"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010019\u201005060\u20100"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1094428104263672"},{"key":"e_1_2_9_7_1","volume-title":"Investigating quality of care for diabetes mellitus, congestive heart failure and chronic kidney disease in Ontario\u2019s Family Health Group and Family Health Organization models (Electronic Thesis and Dissertation Repository)","author":"Bamimore M. 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