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1. Zhang, Xue. Three Essays on Health and Pension Economics.

Degree: PhD, 2017, McMaster University

This thesis comprises two essays in health economics and one on pension economics. The first two essays use the institutional changes (mainly physician payment changes) of primary care reform in Ontario to study the impact of financial incentives on physician behavior and continuity of care. Specifically, we focus on two major primary care physician/General Practitioner (GP) payment model transitions in the reform: from traditional fee-for-service (FFS) to the enhanced FFS (referred as the first transition), and from enhanced FFS to blended capitation (referred to as the second transition). The first essay uses the second transition as a quasi-natural experiment and explores how the payment structure in the blended capitation model influences the provision of health care services by GPs and their practice groups. The second essay uses the first and second transitions to examine the association between continuity of care and patient rostering that is incentivized by premiums and bonuses in the enhanced FFS and the blended capitation model. The last chapter diverges from this topic and addresses one aspect of social insurance, namely pensions in China; it assesses how internal migrants and locals differ in terms of the pension contributions they make and the benefits they receive under the national policies that were recently introduced to reduce the fragmentation of the pension operations.The first chapter examines the switch in physician payment system from FFS to the blended capitation-FFS model on GPs’ billing behavior within a group practice. There are multiple dimensions of payment blending in the blended capitation model: first, a blend of capitation for services inside the capitated basket, which are quite commonly employed and represent a large proportion of the services offered by GPs, and FFS for services outside the basket; second, a blend of capitation and less than full-cost FFS payment for services inside the capitated basket; third, a blend of different payment mechanisms for rostering and non-rostering patients funded under blended capitation or traditional FFS ; fourth, a blend of pay for performance, capitation and FFS (Sweetman and Buckley, 2014). We provide both a theoretical model examining the provision of care inside and outside the capitated basket and an associated econometric analysis using comprehensive administrative data, and the second transition in primary care reform as a quasi-natural experiment. We construct a panel of continuously rostered patient-GP pairs and employ a propensity score weighted difference-in-differences approach to identify the impact of a change in the GPs’ remuneration model on the shifting of services across payment categories which are created by multiple blending dimensions. Consistent with the theory presented, rostering GPs provide fewer capitated services and simultaneously more FFS services. Other GPs within the rostering group reduce service provision within the capitated basket, with no change in FFS services. All other GPs in Ontario have relative… Advisors/Committee Members: Sweetman, Arthur, Economics.

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APA (6th Edition):

Zhang, X. (2017). Three Essays on Health and Pension Economics. (Doctoral Dissertation). McMaster University. Retrieved from

Chicago Manual of Style (16th Edition):

Zhang, Xue. “Three Essays on Health and Pension Economics.” 2017. Doctoral Dissertation, McMaster University. Accessed July 22, 2018.

MLA Handbook (7th Edition):

Zhang, Xue. “Three Essays on Health and Pension Economics.” 2017. Web. 22 Jul 2018.


Zhang X. Three Essays on Health and Pension Economics. [Internet] [Doctoral dissertation]. McMaster University; 2017. [cited 2018 Jul 22]. Available from:

Council of Science Editors:

Zhang X. Three Essays on Health and Pension Economics. [Doctoral Dissertation]. McMaster University; 2017. Available from: