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Does physician compensation for declaration of involuntary status increase the likelihood of involuntary admission? A population-level cross-sectional linked administrative database study

Published online by Cambridge University Press:  19 March 2020

Michael Lebenbaum Open the ORCID record for Michael Lebenbaum [Opens in a new window] ,
Maria Chiu ,
Laura Holder ,
Simone Vigod  and
Paul Kurdyak
Michael Lebenbaum*
Affiliation:
ICES, 2075 Bayview Avenue, G-106, Toronto, Ontario, Canada, M4N3M5 Institute of Health Policy, Management and Evaluation, 155 College St, 4th Floor, Toronto, Ontario, Canada, M5T 3M6
Maria Chiu
Affiliation:
ICES, 2075 Bayview Avenue, G-106, Toronto, Ontario, Canada, M4N3M5 Institute of Health Policy, Management and Evaluation, 155 College St, 4th Floor, Toronto, Ontario, Canada, M5T 3M6
Laura Holder
Affiliation:
ICES, 2075 Bayview Avenue, G-106, Toronto, Ontario, Canada, M4N3M5
Simone Vigod
Affiliation:
ICES, 2075 Bayview Avenue, G-106, Toronto, Ontario, Canada, M4N3M5 Institute of Health Policy, Management and Evaluation, 155 College St, 4th Floor, Toronto, Ontario, Canada, M5T 3M6 Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario, Canada, M5G 1N8 Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8
Paul Kurdyak
Affiliation:
ICES, 2075 Bayview Avenue, G-106, Toronto, Ontario, Canada, M4N3M5 Institute of Health Policy, Management and Evaluation, 155 College St, 4th Floor, Toronto, Ontario, Canada, M5T 3M6 Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8 Center for Addiction and Mental Health, 250 College St, Toronto, Ontario, Canada, M5T 1L8
*
Author for correspondence: Michael Lebenbaum, E-mail: Michael.lebenbaum@ices.on.ca
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Abstract

Background

There is substantial variability in involuntary psychiatric admission rates across countries and sub-regions within countries that are not fully explained by patient-level factors. We sought to examine whether in a government-funded health care system, physician payments for filling forms related to an involuntary psychiatric hospitalization were associated with the likelihood of an involuntary admission.

Methods

This is a population-based, cross-sectional study in Ontario, Canada of all adult psychiatric inpatients in Ontario (2009–2015, n = 122 851). We examined the association between the proportion of standardized forms for involuntary admissions that were financially compensated and the odds of a patient being involuntarily admitted. We controlled for socio-demographic characteristics, clinical severity, past-health care system utilization and system resource factors.

Results

Involuntary admission rates increased from the lowest (Q1, 70.8%) to the highest (Q5, 81.4%) emergency department (ED) quintiles of payment, with the odds of involuntary admission in Q5 being nearly significantly higher than the odds of involuntary admission in Q1 after adjustment (aOR 1.73, 95% CI 0.99–3.01). With payment proportion measured as a continuous variable, the odds of involuntary admission increased by 1.14 (95% CI 1.03–1.27) for each 10% absolute increase in the proportion of financially compensated forms at that ED.

Conclusions

We found that involuntary admission was more likely to occur at EDs with increasing likelihood of financial compensation for invoking involuntary status. This highlights the need to better understand how physician compensation relates to the ethical balance between the right to safety and autonomy for some of the world's most vulnerable patients.

Keywords

Emergency departmentsepidemiologyfinancial paymentsinvoluntary admissions
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 10 , July 2021 , pp. 1666 - 1675
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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