Primary Care Reform

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

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.

Purpose of health policy or idea

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.

Main points

Main objectives

primary care reform to promote comprehensive, co-ordinated care focussing on health promotion

Type of incentives

financial and non-financial (including better working and work-life conditions)

Groups affected

a range of professionals including general practitioners, nurses, physiotherapists, pharmacists, social workers, etc, patients, professional associations and professional regulatory bodies

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

General background

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.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

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.

Stakeholder positions

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.

Influences in policy making and legislation

A regulation under Ontario's Development Corporations Act established the Ontario Family Health Network as a corporation at arms-length from government.

Adoption and implementation

• As of the end of February 2003, 129 of Ontario's doctors had joined 15 different family health networks on a voluntary.  This represents a small percentage of Ontario's family physicians.  The government's stated goal is to have 80% of physicians working in family health networks by the end of 2004.  Future questionnaires will track progress towards this goal and the effect of the 2003 Health Accord in this regard.
• Other provincial governments have developed their own programs to promote the reform of primary care.  As previously mentioned, most programs remain at the pilot project stage. 

Expected outcome

References

Sources of Information

www.hc-sc.gc.ca/english/hca2003/accord.html

Author/s and/or contributors to this survey

Cathy Fooks, Lisa Maslove

Empfohlene Zitierweise für diesen Online-Artikel:

Cathy Fooks, Lisa Maslove. "Primary Care Reform". Health Policy Monitor, September 2002. Available at http://www.hpm.org/survey/ca/b1/2