Evaluation of the case mix and equity of age-sex adjusted primary care capitation payment models in Ontario, Canada

Several innovative models for primary care delivery have recently been introduced in Ontario, Canada. These group-practice models share common characteristics of patient rostering, age-sex based capitation rates, and performance-based incentives. These models have been adopted because of their potential strengths to reduce the overall cost of care, improve effective medical care management, and increase the use of appropriate preventative-care measures. There is concern, however, that age-sex adjusted capitation rates alone do not take into account variations in the morbidity burden and the healthcare needs that are associated with socioeconomic status. The objective of this study is to compare capitation remuneration rates, by socioeconomic status (SES), with the morbidity burden and the expected primary care resource use of patients enrolled to primary care physicians in the most established capitation model -- Family Health Networks (FHN).