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Primary care in Ontario, Canada: New proposals after 15 years of reform

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  • Marchildon, Gregory P.
  • Hutchison, Brian

Abstract

Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province.

Suggested Citation

  • Marchildon, Gregory P. & Hutchison, Brian, 2016. "Primary care in Ontario, Canada: New proposals after 15 years of reform," Health Policy, Elsevier, vol. 120(7), pages 732-738.
    • Handle: RePEc:eee:hepoli:v:120:y:2016:i:7:p:732-738
    DOI: 10.1016/j.healthpol.2016.04.010
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    References listed on IDEAS

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    1. David Rudoler & Raisa Deber & Janet Barnsley & Richard H. Glazier & Adrian Rohit Dass & Audrey Laporte, 2015. "Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1229-1242, September.
    2. Rudoler, David & Laporte, Audrey & Barnsley, Janet & Glazier, Richard H. & Deber, Raisa B., 2015. "Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada," Social Science & Medicine, Elsevier, vol. 124(C), pages 18-28.
    3. Jeremiah Hurley & Phil DeCicca & Jinhu Li & Gioia Buckley, 2011. "The Response of Ontario Primary Care Physicians to Pay-for-Performance Incentives," Centre for Health Economics and Policy Analysis Working Paper Series 2011-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
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    Cited by:

    1. Nibene H. Somé & Rose Anne Devlin & Nirav Mehta & Gregory S. Zaric & Sisira Sarma, 2020. "Stirring the pot: Switching from blended fee‐for‐service to blended capitation models of physician remuneration," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1435-1455, November.
    2. Jason Sutherland, 2021. "Health Care Funding Policies for Reducing Fragmentation and Improving Health Outcomes," SPP Research Papers, The School of Public Policy, University of Calgary, vol. 14(37), December.
    3. McKay, Madeleine & Lavergne, M. Ruth & Lea, Amanda Prince & Le, Michael & Grudniewicz, Agnes & Blackie, Doug & Goldsmith, Laurie J. & Marshall, Emily Gard & Mathews, Maria & McCracken, Rita & McGrail,, 2022. "Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan," Health Policy, Elsevier, vol. 126(6), pages 565-575.
    4. Marchildon, Gregory P. & Brammli-Greenberg, Shuli & Dayan, Mark & De Belvis, Antonio Giulio & Gandré, Coralie & Isaksson, David & Kroneman, Madelon & Neuner-Jehle, Stefan & Saunes, Ingrid Sperre & Tho, 2021. "Achieving higher performing primary care through patient registration: A review of twelve high-income countries," Health Policy, Elsevier, vol. 125(12), pages 1507-1516.
    5. Peckham, Allie & Morton-Chang, Frances & Williams, A. Paul & Miller, Fiona A., 2018. "Rebalancing health systems toward community-based care: The role of subsectoral politics," Health Policy, Elsevier, vol. 122(11), pages 1260-1265.
    6. Ghiotto, Maria Cristina & Rizzolo, Ylenia & Gandolfo, Elisabetta & Zuliani, Emanuela & Mantoan, Domenico, 2018. "Strengthening primary care: The Veneto Region’s model of the Integrated Medical Group," Health Policy, Elsevier, vol. 122(11), pages 1149-1154.
    7. Richard Cookson & Luke Mondor & Miqdad Asaria & Dionne S Kringos & Niek S Klazinga & Walter P Wodchis, 2017. "Primary care and health inequality: Difference-in-difference study comparing England and Ontario," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-15, November.
    8. Somé, N.H. & Devlin, R.A. & Mehta, N. & Zaric, G.S. & Sarma, S., 2020. "Team-based primary care practice and physician's services: Evidence from Family Health Teams in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 264(C).
    9. Maude Laberge & Walter P. Wodchis & Jan Barnsley & Audrey Laporte, 2016. "Efficiency of Ontario primary care physicians across payment models: a stochastic frontier analysis," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    10. Nadine Chami & Arthur Sweetman, 2019. "Payment models in primary health care: A driver of the quantity and quality of medical laboratory utilization," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1166-1178, October.
    11. Rice, Kathleen & Webster, Fiona, 2017. "Care interrupted: Poverty, in-migration, and primary care in rural resource towns," Social Science & Medicine, Elsevier, vol. 191(C), pages 77-83.
    12. Nibene Habib Somé & Rose Anne Devlin & Nirav Mehta & Sisira Sarma, 2024. "Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2288-2305, October.
    13. Vu, Thyna & Anderson, Kelly K. & Devlin, Rose Anne & Somé, Nibene H. & Sarma, Sisira, 2021. "Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models," Social Science & Medicine, Elsevier, vol. 268(C).
    14. Allin, Sara & Martin, Elisabeth & Rudoler, David & Church Carson, Michael & Grudniewicz, Agnes & Jopling, Sydney & Strumpf, Erin, 2021. "Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces," Health Policy, Elsevier, vol. 125(9), pages 1121-1130.
    15. Rudoler, David & Peckham, Allie & Grudniewicz, Agnes & Marchildon, Greg, 2019. "Coordinating primary care services: A case of policy layering," Health Policy, Elsevier, vol. 123(2), pages 215-221.
    16. Nibene H. Somé & Rose Anne Devlin & Nirav Mehta & Greg Zaric & Lihua Li & Salimah Shariff & Bachir Belhadji & Amardeep Thind & Amit Garg & Sisira Sarma, 2019. "Production of physician services under fee‐for‐service and blended fee‐for‐service: Evidence from Ontario, Canada," Health Economics, John Wiley & Sons, Ltd., vol. 28(12), pages 1418-1434, December.
    17. Polin, Katherine & Hjortland, Maximilien & Maresso, Anna & van Ginneken, Ewout & Busse, Reinhard & Quentin, Wilm, 2021. "“Top-Three” health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview," Health Policy, Elsevier, vol. 125(7), pages 815-832.
    18. Antonipillai, Valentina & Guindon, G. Emmanuel & Sweetman, Arthur & Baumann, Andrea & Wahoush, Olive & Schwartz, Lisa, 2021. "Associations of health services utilization by prescription drug coverage and immigration category in Ontario, Canada," Health Policy, Elsevier, vol. 125(10), pages 1311-1321.
    19. Zhang, Xue & Sweetman, Arthur, 2018. "Blended capitation and incentives: Fee codes inside and outside the capitated basket," Journal of Health Economics, Elsevier, vol. 60(C), pages 16-29.

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