Primary Care In Canada: So Much Innovation, So Little Change Policymakers, in pursuit of a "big bang," may have missed crucial opportunities to improve primary care in Canada

Department of Family Medicine, and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario.
Health Affairs (Impact Factor: 4.97). 05/2001; 20(3):116-31. DOI: 10.1377/hlthaff.20.3.116
Source: PubMed


The development of Canadian primary care has been shaped by a series of policy legacies that continue to affect the possibilities for change in primary care through their cumulative effects on the health care system and the process of health policy development. The pursuit of radical systemwide change in the face of unfavorable circumstances (created in large part by those legacies) has resulted in missed opportunities for cumulative incremental change. While major changes in primary care policy seem unlikely in the near future, significant incremental change is possible, but it will require a reorientation of the policy development process.

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    • "Since physicians may equate primary care reform largely with a switch to capitated payment, the successful recruitment to the Network will require the education of physicians about payment. Borrowing from strategy used to introduce Health Services Organizations, government suggested a process to compare the fee-for-service billings of potential recruits with their possible earnings under Network rules [1,16]. Additionally, they need to emphasize that a selection of retained fee-for-service billing codes and the system of target achievement bonuses brings the Network's payment formula closer to a blended scheme favoured by many physicians [1,19]. "
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    ABSTRACT: Primary care reform initiatives in Ontario are proceeding with little information about the views of practicing family physicians. A postal questionnaire was sent to 1200 randomly selected family physicians in Ontario five months after the initial invitation to join the Ontario Family Health Network. It sought information about their practice characteristics, their intention to participate in the Network and their views about the organization and financing of primary care. The response rate was 50.3%. While many family physicians recognize the need for change in the delivery of primary care, the majority (72%) did not expect to join the Ontario Family Health Network by 2004, or by some later date (60%). Nor did they favour capitation or rostering, 2 key elements of the proposed reforms. Physicians who favour capitation were 5.5 times more likely to report that they expected to join the Network by 2004, although these practices comprise 5% of the sample. The results of this survey, conducted five months after the initial offering of primary care reform agreements to all Ontario physicians, suggest that an 80% enrollment target is unrealistic.
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