Abstract
This study shows how practice factors, particularly payment type, affect quality and accessibility of primary care for adults with disabilities. The study consisted of: (a) a survey of practice characteristics, including accessibility, accommodations for disabled patients, and payment type; and, (b) a retrospective chart audit for quality of care indicators. The sample consisted of 513 patients within 73 doctors within 47 practices. The study show that there are significant differences between payment types on location, number of physicians and other health professionals, caseloads and patient contacts. Salaried practices scored significantly higher on accessibility and willingness to make accommodations for patients with disabilities. Salary practices scored significantly higher than FFS or capitation for the treatment of diabetes, hypertension and urinary tract infections. Capitation practices scored significantly lower than the other two payment types on preventive care. These findings raise questions regarding the mix of salary to other models of practice, and incentives for ensuring that those with the greatest need receive the best possible primary care.
Get full access to this article
View all access options for this article.
