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Oh look, capitation billing; also, CBC health writers let me down again!

May 26, 2009

Capitation-model billing seemed like a good idea. Doctors don’t have to worry so much about cramming in as many visits in a day as possible, and instead can think more about managing the needs of their patient population in general. Sounds good to me! But maybe some of our fears about its implementation are coming true.

As if finding a doctor wasn’t already hard enough, the CBC reports that this billing model is meaning that capitation-billing GPs are taking healthier (and wealthier) patients and that it will probably remain that way until billing is better adjusted for ‘difficult’ patients. Well, looking at the original article in the CMAJ, part of that is true, but not all of it.

The bit about healthier patients in the capitation-model is true. Glazier et al wrote that “those whose physicians were in the capitation group were less likely to have chronic conditions and had less morbidity and comorbidity compared with patients whose physicians were in the enhanced fee-for-service group.” I am surprised that, though the CBC presented the same excerpt, they did not focus on what I think was one of the key findings: “Compared with practices in the enhanced fee-for-service model, those in the capitation model had patients who . . .  received less after-hours care and had more visits to emergency departments.” So the capitation scheme is making for a greater burden on the ERs when it was designed, in part, to ease that stress. But that’ topic is not what this particular blog entry is for.

I could rant and rave about the poor quality of CBC’s health stories – especially in reporting study findings – and I adamantly suggest that their writers get some training in statistics, study design, and critical reading. I think the downward trend in their quality started around the time they published the results of an anti-depressant meta-analysis; the CBC reporter failed to critique the study, when anyone who read it would note that the meta-analysis threw out most of the long term trials, meaning that most of the retained studies were less than 4 weeks. And a good health reporter knows that antidepressants often take at least 4 weeks before their full therapeutic effect is reached. But I digress!

My qualm with today’s particular article is that the CBC’s angle seems to be the economic disparity bit. But the article says “the age, sex and socioeconomic characteristics of patients were similar across the capitation and enhanced fee-for-service groups.” So I’m not really sure where they got this line: “The study . . . showed many of these new patients who found family doctors under the capitation model were healthier and wealthier on average.”

Since when is our national news service allowed to make stuff up! Start reading the articles and not just the abstract! Stop sucking at reporting the facts! You can do it, CBC!

Check out the article in the CMAJ, (http://www.cmaj.ca/cgi/reprint/180/11/E72) or the CBC’s (poor) take on it (http://www.cbc.ca/health/story/2009/05/26/ontario-family-doctors.html).

What do you think about the quality of CBC health reporting lately?

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