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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

Puyat, Joseph H. PhD; Kazanjian, Arminee Dr Soc; Wong, Hubert PhD; Goldner, Elliot M. MD, MHSc, FRCPC

doi: 10.1097/MLR.0000000000000639
Original Articles

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.

*School of Population and Public Health, University of British Columbia

Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada

Permission to use the linked health administrative data was granted by the BC Ministry of Health, Data Stewardship Committee, and BC Vital Statistics Agency. Data access was facilitated by Population Data BC. J.H.P. is supported by a Canadian Institutes of Health Research Banting and Best Doctoral Research Award and a UBC 4-Year Fellowship Award.The views expressed in this article are those of the authors and do not necessarily reflect the official views of any of the agencies mentioned.

A portion of the study results has been presented as a conference poster at the Canadian Academy of Psychiatric Epidemiology meeting in Vancouver on September 30, 2015.

The authors declare no conflict of interest.

Reprints: Joseph H. Puyat, PhD, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3. E-mail:

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