|Implemented in this survey?|
Primary health care is important in improving population health to deliver services more efficiently, the Canadian ministry of health has adopted a primary care reform which includes better coordination of care particularly for chronic disease populations, greater patient involvement in care decisions and a more efficient use of health care resources.
The majority of Canadian general practitioners and family physicians are paid on a fee-for-service basis for providing mostly curative and rehabilitative services. Primary care reform would
see patients cared for by an interdisciplinary team of professionals who would focus on wellness and health promotion activities both at the individual level and for the populations they serve.
Care would be accessible 24 hours a day, seven days a week.
Primary care reform would have to employ a number of policy tools including a change to the financial incentives faced by physicians and other professionals. The most common remuneration recommendation is a mixture of capitation, fee-for-service and program funding to encourage professionals to provide co-ordinated, comprehensive care with a focus on prevention.
The main objectives of primary care reform include better co-ordination of care particularly for chronic disease populations, greater patient involvement in care decisions and a more efficient use of health care resources.
primary care reform to promote comprehensive, co-ordinated care focussing on health promotion
financial and non-financial (including better working and work-life conditions)
a range of professionals including general practitioners, nurses, physiotherapists, pharmacists, social workers, etc, patients, professional associations and professional regulatory bodies
|Medienpräsenz||sehr gering||sehr hoch|
For decades, health policy commissions and analysts have cited primary care reform as necessary in improving population health and delivering services more efficiently. There are numerous local initiatives and pilot projects across Canada, though no province has made large-scale reforms to the delivery of primary care.
|Implemented in this survey?|
Most recently, primary care reform has been recommended by all eight national and provincial health reform reports released during the last five years, including two high-profile national reports
released in Autumn 2002 (these are the Commission on the Future of Health Care in Canada and the Senate Standing Committee on Social Affairs, Science and Technology).
This idea echoed earlier calls for primary care reform and has been influenced by the experience with primary care teams in the United Kingdom and other jurisdictions.
There are numerous examples of local groups of professionals providing primary care in arrangements other than fee-for-service payment. There are also several pilot projects, most reliant on short-term funding.
A September 2000 First Ministers meeting resulted in an $800 million Primary Health Care Transition Fund. These funds have been used by the provinces to support pilot projects though a
considerable portion of the funds remains unused.
At their subsequent health care meeting in February 2003, the First Ministers reached a Health Accord (www.hc-sc.gc.ca/english/hca2003/accord.html) which included the goal of ensuring 24 hour a day, 7 day a week access to "an appropriate health care provider". The federal budget of the same month included funds to support this (and other) goals of the Accord.
While physicians' groups have expressed support for the general idea of working in interdisciplinary teams, they are concerned about the accountabilities of these teams including whether the physician would remain the central primary care provider.
Individual provinces have gone farther than a policy paper in accepting primary care reform. In the remainder of this questionnaire, the province of Ontario will be used as a case study. In Ontario, the provincial government and the Ontario Medical Association (the organisation representing Ontario's physicians) have negotiated a series of agreements around the rights and responsibilities of physicians and patients participating in particular new models of primary care. These agreements also address issues around physician remuneration. In March 2001, the government set up the Ontario Family Health Network as an agency to administer the agreements (www.ontariofamilyhealthnetwork.gov.on.ca). Participation by both physicians and patients remains voluntary.
A regulation under Ontario's Development Corporations Act established the Ontario Family Health Network as a corporation at arms-length from government.
Cathy Fooks, Lisa Maslove