Impact of Incentive Reform & COVID-19 on Primary Care Home Visits in Ontario: A Population-Based Interrupted Time Series Analysis, 2026, Jones

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Impact of Incentive Reform and COVID-19 on Primary Care Home Visits in Ontario: A Population-Based Interrupted Time Series Analysis​

Aaron Jones, Anastasia Gayowsky, Chi-Ling Joanna Sinn, Rebecca H. Correia, Darly Dash, Bahram Rahman, Maggie (Hong) Meng, Heebah Sultan, Elizabeth Niedra, Andrew P. Costa, Noah Ivers, R. Liisa Jaakkimainen, Jennifer A. Watt and Lauren Lapointe-Shaw
The Annals of Family Medicine January 2026, 24 (1) 44-51; DOI: https://doi.org/10.1370/afm.250314

Abstract​

BACKGROUND Home visits provide essential access to primary care for frail or homebound older adults. In Ontario, Canada, a 2019 policy change removed some financial incentives for physicians to conduct home visits. This was followed by the COVID-19 pandemic and rapid adoption of virtual care, potentially disrupting the provision of home visits.

METHODS We conducted a population-based interrupted time series analysis of Ontario residents aged ≥65 years during the period July 2014 to June 2024. The interruptions were an incentive reform in October 2019 and the onset of COVID-19 in March 2020. The main outcome was the monthly number of primary care home visits per 10,000 older adults, standardized by age and sex. Segmented autoregressive models estimated changes in level and trend at interruption. Secondary analyses examined differences by age, rurality, dementia status, and visit type (palliative vs nonpalliative).

RESULTS From July 2014 to September 2019, home visits increased by 0.14 (95% CI, 0.05-0.23) visits per 10,000 residents per month. From October 2019 to June 2020, visits decreased by 29.7% (95% CI, 26.0%-33.1%). There was no significant postinterruption trend. Nonpalliative visits decreased more sharply (34.5%) than palliative visits (21.3%).

CONCLUSIONS Home visits decreased sharply after incentive reform and the COVID-19 pandemic, with no evidence of recovery except among palliative visits. These findings suggest a structural shift in primary care delivery. Further research should investigate consequences on health outcomes for older adults and optimal models of primary care for older adults with challenges accessing office-based care.
Key words:

• home visits
• aged
• primary health care
• time series studies

 

[Dolphin]

Primary care home visits for older adults declined after payment policy changes and COVID-19 in Ontario, Canada

In Ontario, primary care home visits, which help older adults who are homebound or have difficulty getting to a clinic, increased during the 2010s but declined after a 2019 policy change reduced payment incentives and the COVID-19 pandemic began. This study examined how primary care home visits...

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News Release 26-Jan-2026

Primary care home visits for older adults declined after payment policy changes and COVID-19 in Ontario, Canada​

Impact of incentive reform and COVID-19 on primary care home visits in Ontario: A population-based interrupted time series analysis

Peer-Reviewed Publication
American Academy of Family Physicians


Original Research

Primary Care Home Visits for Older Adults Declined After Payment Policy Changes and COVID-19 in Ontario, Canada

Background: In Ontario, primary care home visits, which help older adults who are homebound or have difficulty getting to a clinic, increased during the 2010s but declined after a 2019 policy change reduced payment incentives and the COVID-19 pandemic began. This study examined how primary care home visits for adults aged 65 years and older changed from 2014 to 2024.

What They Found: Researchers used population-level health administrative data and an interrupted time series analysis of monthly home visit rates for Ontario residents aged 65 years and older. Home visits increased slightly before 2019 but dropped sharply by nearly 30 percent during the period from October 2019 through June 2020, which included the incentive change and early COVID-19 disruptions. Visit rates did not recover through 2024 and remained about one-third lower than expected. Nonpalliative home visits (routine primary care not focused on end-of-life care) declined more than palliative home visits, which were the only type to show growth after 2020.

Implications: Primary care home visits for older adults declined substantially and did not rebound after policy changes and COVID-19, suggesting a lasting shift in how care is delivered. Impact of Incentive Reform and COVID-19 on Primary Care Home Visits in Ontario: A Population-Based Interrupted Time Series Analysis

Aaron Jones, PhD, et al

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

ICES, Toronto, Ontario, Canada

Centre for Integrated Care, St Joseph’s Health System, Hamilton, Ontario, Canada

PRE-EMBARGO LINK (Temporary)

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Journal​

The Annals of Family Medicine

Article Title​

Primary Care Home Visits for Older Adults Declined After Payment Policy Changes and COVID-19 in Ontario, Canada

Article Publication Date​

26-Jan-2026

 

[Dolphin]

I’ve heard a lot of talk that doctors should do home visits for people with severe ME. But no or barely any talk that to increase the chances, doctors/practices probably need to be offered incentives.