Health care in Canada is primarily publicly funded (through a variety of tax revenues), and privately delivered. Most primary care physicians run clinics as independent, small businesses and bill provincial health insurance plans (e.g., British Columbia Medical Services Plan (MSP)) on a fee-for-service basis; however, alternative models of payment such as capitation are becoming increasingly common in some provinces (though not in BC) [43]. Primary care physicians in Canada serve a coordinating and gate-keeping function; patients require a referral from a primary care physician to see a specialist. BC is divided into five regional health authorities that are responsible for service delivery within their respective geographic regions.

We used the British Columbia (MSP) Consolidation file [44] to identify patients who were registered to receive MSP-insured services for the entire period of 2005/2006 through 2011/2012. The Consolidation file also contains basic patient demographic data including age, sex, regional health authority (region) of residence, and income quintile.

Using unique patient-level identifiers, we linked the Consolidation file data to the MSP Physician Payment Database [45], which is a record of all physician–patient interactions billed on a fee-for-service (FFS) basis. These interactions (visits) include any face-to-face consultation between a physician and patient regardless of location (e.g., urgent care or community clinic). We used this data source to identify the Majority Source of Care (MSOC) for each patient, defined as the physician who provided more than 50% of their primary care contacts. To calculate this measure, patients must have had a minimum of three primary care visits in a single calendar year. This was necessary to ensure more accurate assignment of physicians to patients; it also permitted us to focus on a population likely to be most affected by any changes in primary care interactions surrounding retirement. We identified patients’ MSOCs only for 2005/2006 and 2006/2007 to avoid artificially limiting our sample to very high users.

We supplemented MSP FFS billings with data from the Alternative Payment Plan database, which tracks payments to physicians outside of the traditional FFS model. This allowed us to confirm that physicians who ceased billing MSP did in fact retire, rather than move to an alternative payment model.

We also used data from the MSP Physician Payment Database [45] and from hospital separations data [46] to quantify the level of morbidity for each patient, using Johns Hopkins Aggregated Diagnostic Groupings (ADGs). ADGs are generated using the International Classification of Diseases, 9th and 10th Revisions, diagnostic codes attached to specific health services utilization [47, 48]. We focused on eight of 32 possible ADGs that are considered to be “major conditions” [47, 48].

Finally, we used data from the College of Physicians and Surgeons of BC physician registry [49] as a source for physician demographic data including age, sex, and training location (Canada or international) of each MSOC physician.

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