Does a Pay-for-Performance Program for Primary Care Physicians Alleviate Health Inequity in Childhood Vaccination Rates?

International Journal for Equity in Health (2015) 14:114

7 Pages Posted: 5 Dec 2015

See all articles by Alan Katz

Alan Katz

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Jennifer Enns

University of Manitoba - Department of Community Health Sciences (CHS)

Dan Chateau

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Lisa Lix

University of Manitoba - Max Rady College of Medicine

Douglas P. Jutte

University of California, Berkeley

Jeanette Edwards

Winnipeg Regional Health Authority

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Colleen J Metge

University of Manitoba - Manitoba Centre for Health Policy

Nathan Nickel

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Carole Taylor

University of Manitoba - Manitoba Centre for Health Policy

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy

Date Written: 2015

Abstract

Introduction: Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates.

Methods: The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1-Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.

Results: The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95% CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95% CI 0.008, 0.021).

Conclusions: The P4P program had a limited impact on vaccination rates and did not address health inequity.

Keywords: Health equity, Income inequality, Childhood, Immunization, Vaccination, Manitoba, Canada

Suggested Citation

Katz, Alan and Enns, Jennifer and Chateau, Dan and Lix, Lisa and Jutte, Douglas P. and Edwards, Jeanette and Brownell, Marni D. and Metge, Colleen J and Nickel, Nathan and Taylor, Carole and Burland, Elaine, Does a Pay-for-Performance Program for Primary Care Physicians Alleviate Health Inequity in Childhood Vaccination Rates? (2015). International Journal for Equity in Health (2015) 14:114. Available at SSRN: https://ssrn.com/abstract=2698802

Alan Katz (Contact Author)

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Jennifer Enns

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

Dan Chateau

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Lisa Lix

University of Manitoba - Max Rady College of Medicine ( email )

Winnipeg
Canada

Douglas P. Jutte

University of California, Berkeley ( email )

310 Barrows Hall
Berkeley, CA 94720
United States

Jeanette Edwards

Winnipeg Regional Health Authority ( email )

496 Hargrave Street
Winnipeg, Manitoba R3A 0X7
Canada

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Colleen J Metge

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Nathan Nickel

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Carole Taylor

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

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