Effect of Physician Remuneration Fees on Glaucoma Procedure Rates in Canada

Abstract

Methods: : Canadian provincial health insurance databases were accessed to obtain yearly totals of trabeculoplasties, trabeculectomies and glaucoma drainage device implantations (GDD) from 1992 until 2007. An age-stratified glaucoma prevalence model was applied to provincial population census data to estimate the number of individuals with glaucoma. Provincial remuneration fees from 1992 until 2007 were obtained. Regression analyses were performed to evaluate the influence of fees on procedure rates. First, we examined the effects of differences in remuneration between provinces and across time points. Second, for each type of procedure, we examined the effects of differences in the relative remuneration compared to other glaucoma procedures.

Results: : During the study period we found that trends in procedure rates varied widely among provinces. From 1992 to 2007 provincial trabeculoplasty rate trends ranged from a decrease of 98% to an increase of 380%, trabeculectomy rate trends ranged from a decrease of 72% to an increase of 42%, and GDD implantation rate trends ranged from a decrease of 32% to an increase of 1292%. Physician fees also varied widely between provinces. For example, in 2007 the provincial remuneration varied from $125 to $663 for trabeculoplasties, $370 to $748 for trabeculectomies and $426 to $956 for GDD. Linear regression modeling found that for every $100 increase in fee there were 10.5 more trabeculoplasties (p=0.08), 1.2 fewer trabeculectomies (p=0.19) and 0.02 more GDD (p=0.92) per 1000 persons at risk for glaucoma. A linear regression model examining the relative fee of one procedure compared to the two other procedures in the same province did not find any association between relative remuneration and procedure rate.

Conclusions: : Physician renumeration fees did not influence glaucoma procedure rates in Canada during the study period.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: systems/equipment/techniques • laser