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The Price-Baker report: What does it mean for primary care reform in Ontario?


Making doctors responsible for the patients in their geographical area. Offering primary care after-hours and on the weekends. And pushing away from solo practitioners and towards interprofessional care.

Those proposals were all in the recently released “Patient Care Groups: A new model of population based primary health care for Ontario,” led by McMaster University’s David Price and nurse practitioner Elizabeth Baker. The report suggests a fundamental shift in how primary care is delivered, calling for a model where doctors would serve everyone in a geographic area and be organized under Patient Care Groups.

The Ministry of Health and Long-Term Care asked the expert advisory committee that created the report to address a number of issues. They were asked to propose a system that would offer everyone in Ontario access to a primary care provider, an interprofessional team and care in the evenings and on the weekends. And they were tasked with integrating primary care into the health care system.

The team soon realized that they would have to make sweeping changes, says Price. “It became clear to us that nobody had really articulated a coherent vision for primary care and primary health care,” he says. “I think where we have failed in our work in primary care is that we’ve tried to create initiatives that address a single aspect, but don’t touch the broader system.”

Groups like the Ontario Medical Association say the team should have consulted primary care providers more thoroughly and that Patient Care Groups are an additional layer of bureaucracy Ontario can’t afford. Others, like the Ontario College of Family Physicians and the Association of Ontario Health Centres, are anxious for details about exactly how it would be implemented.

Deputy Minister of Health Bob Bell offered the first insights on that last week, when he spoke about what the province was interested in from the report – and what they wouldn’t be acting on – in the College of Family Physicians of Canada’s Family Medicine Forum.

Here’s what we know so far about the report and what the government is planning to implement. 

The Price-Baker Report’s suggestions

Getting in to see a doctor should be as easy as enrolling a child in a school, says the report. It proposes that patients within a certain area be automatically eligible to register with one of the family doctors or nurse practitioners serving it.

That would offer all Ontarians access to a primary care provider. “It staggers me that we say it’s unacceptable for a child to move into a district and not get schooling and yet in a first world country we say it’s acceptable for a citizen to move into an area and not get primary care,” says Price.

That doesn’t mean people would lose their current family doctor: Those who already have a care provider would be able to stay with them. And people who prefer a doctor near their work, or need specialized care – like geriatric physicians – could choose primary care providers from outside their catchment area.

The government seems to be embracing that concept. In his speech, Bell said they’re “very interested in the concept of geographic-based, risk-adjusted, population-based primary care,” under a model “that would say, ‘everyone who wants access to a primary care provider within this geographic region should have that.’”

The report suggests that access be coordinated by Patient Care Groups (PCGs). The PCG teams would be made up of an executive director, clinical lead, care coordinator and patient representative. The roles could be taken on by existing organizations, such as Family Health Teams and would report to the Local Health Integration Networks (LHINs).

The LHINs, in turn, would help do the health human resources planning and needs assessments of the communities, disseminate best practices and contract resources such as information technology.

Bell said primary care would be led by local “thought leaders in the community and by administrative resources, probably from the LHINs.”

The PCGs would also coordinate care and assess quality standards. Like hospitals, they would have accountability agreements that would make them responsible for hitting health indicators at both the patient and population levels. Those goals would be created by the ministry of health, with the input of Health Quality Ontario, the LHIN and Public Health and could be tailored to the specific area.

They would also ensure patients have access to after-hours and weekend care – Bell suggested offering primary care until 8 p.m. – as well as a certain number of same- or next-day appointments.

All group practices would be required to provide after-hours and weekend care. Solo practitioners would also have to offer after-hours care, but how they do it would be up to them: perhaps by partnering together with other practitioners, using a shared electronic medical record system, and rotating after-hours shifts, or by working with urgent care centres. It could also be coordinated through walk-in clinics or emergency departments, an option that would be especially useful in rural areas.

Beyond offering more access, the PCGs would also help integrate primary care with other parts of the health-care system, such as hospitals or long-term care. And it would allow them to share best practices with each other. “[Primary care providers] are still siloed, not just among categories of providers, but even within ourselves,” says Baker. “One family health team down the street could be completely different than another.”

Finally, the report suggested the PCGs be funded on a per-capita basis, adjusted for patient needs. They would then contract the care in the area to doctors and nurse practitioners – and could decide “which provider payment mechanisms are most appropriate.” (Price clarified in an interview that the committee’s “direction and conversation was that physician compensation was the purview of the OMA and the Ministry of health.”)

That’s one area that doesn’t seem ready for reform – especially in the midst of the heated fee negotiations between the Ontario government and the OMA. “The one thing I can tell you is that David recommended a different system of funding for physician compensation within the patient care groups, [and] we can’t go there. We simply can’t,” said Bell, saying the government “would not dream” of changing the funding for primary care without working with the OMA.

Where Ontario stands on primary care

As a result of the primary care reforms in Ontario over the past decade, the number of adults in the province who have access to a primary care provider has risen from 92% in 2006 to 94% in 2015. Northern Ontarians have lower rates, at 88%, as do recent immigrants, at 86%.

One of the most significant changes over that time was encouraging doctors to move away from working independently and towards group care. Now, nearly four million Ontarians now have access to interprofessional care, with over three-quarters of that coming from family health teams.

But thanks to limited monitoring and enforcement, promised after-hours and weekend care hasn’t materialized, with walk-in clinics and emergency rooms often filling the gaps. In the 2104 Commonwealth Fund health policy report, which surveyed older adults, 51% of those surveyed said it was difficult to get after-hours or weekend care without going to the emergency department – placing Canada last out of 11 countries. That puts unnecessary strain on our emergency departments, with 1 in 5 of the visits there being for an illness that could be treated by a primary care provider.

The family health teams are also less likely to serve newcomers to the province, those who are in low-income neighbourhoods and people with comorbidities.

“It’s really clear to us that we’ve developed an inequity in our system,” says Price. “There are those citizens who have access to interprofessional care providers and those that don’t. There are those who have access to a family practice system that provides evenings and weekend coverage and those that don’t. There are those that have access to coverage when their family doctors are on holiday and many that don’t.”

Boon or bureaucracy? The reaction to the report

When the Baker-Price report came out, some argued that Patient Care Groups would be an additional administration burden the province couldn’t afford. “The report talks about what we think looks like another layer of bureaucracy, at a time when health care resources are limited,” says Ontario Medical Association president Mike Toth. “We wonder where the resources are going to come from to fund this.”

Adrianna Tetley, CEO of the Association of Ontario Health Centres, agrees. “We don’t need another layer. That was the biggest reaction of all of our members,” she says.

The PCGs are in fact a layer of administration – and that’s just what’s needed, because there is none now, argues Price. “We would never accept that a hospital wouldn’t have some level of bureaucracy. If you had a hospital where the ORs, specialists, food services were all working independently, imagine what kind of a hospital would you have? That’s precisely what we have in primary care.”

Tetley does agree with the fundamental principle of the report, however, saying it is time for primary care to be offered in a more structured way than wherever a doctor decides to hang their shingle. “Designing the primary care system based on the needs of the people, rather than the needs of the providers, is really a critical piece.” She also thinks the accountability measures are “absolutely overdue. Anybody who gets any health care dollars needs to be held accountable for those dollars,” she says. 

Many more expressed their concerns about how, exactly, this would be implemented. Price says that’s outside of the report’s scope. “This is a concept document,” he says. “We were trying to set an overall vision and an aspirational goal of where we felt we could get to in three years.”

Groups like the Ontario College of Family Physicians are anxiously awaiting the details. “Part of what we’re hearing from membership is that there’s some desire to have a clearer sense of direction,” says Sarah-Lynn Newbery, president-elect of the OCFP and one of the members of the report’s expert advisory committee. “People are really hungry to understand what the vision is for primary care and what the specifics of that vision are: the extent to which population based care will be developed, the ways interprofessional providers can be accessed by patients whose physicians do not currently work in teams and what accountability for performance metrics will really mean.”

The government is creating a unified plan, looking at the Price-Baker Report and the Donner report on home care, among others, said Health Minister Eric Hoskins in a speech earlier this month. He spoke of the LHINs playing a greater role, as part of the goal to have more local governance. He also talked about the importance of integration.

“There is perhaps no more important quality of a health care system that puts patients first than the quality of being integrated,” he said. “That goes for our system of primary care… and our home and community care system as well.”

Implementing the Baker-Price report may be challenging. Robert Cushman, former CEO of the Champlain LHIN and ex-Medical Officer of Health for Ottawa, describes it as “more stick than carrot,” and says it will be difficult to push through existing stakeholders. The OMA dispute will only make that process harder. “The timing couldn’t be worse,” he says.

Yet he’s optimistic about the possibility. “I subscribe to the notion that if you’re going to build a health care system, you have to build it from the bottom up – primary care has to be really strong,” he says. “Giving it a rock-solid foundation, the way this does, has the potential to make a big difference.”

What parts of the Baker-Price report should be implemented?

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31 comments

  1. Jon Johnsen

    This is an interesting overview of Price-Baker and the potential challenges ahead in primary care. I do take exception to the statement that: “But thanks to limited monitoring and enforcement, promised after-hours and weekend care hasn’t materialized,”

    Since the implementation of FHGs, FHNs and FHOs many more family physicians are providing evening and weekend care. Monitoring and enforcement of this could be improved, but it’s important not to throw the baby out with the bath water. These models have improved access.

    • Alex

      I don’t know why we are re-inventing the wheel when we already have the solution. Team-based interprofessional care with alternate funding arrangements to fee-for-service is the answer to many of our primary care problems. The FHT/FHOs should be opened up and expanded. Unfortunately the government is limiting doctors from entering these teams. There is already a managed entry program that limits doctors from entering team based care. On top of that, they have added the New Graduate Entry Program which will be a major financial deterrent from new grads entering the team based model.

  2. Alex

    I have many concerns. If we assign patients to doctors, like we assign students to schools, there needs to be appropriate limits on how many patients a doctor can reasonably be expected to take care of. Teachers have set limits on classroom sizes. We need to set limits on practice sizes, or at least compensate doctors for managing a larger volume of patients. If this is just a strategy to force doctors to take on more patients than they can already handle in an effort to give everyone a family doc, it is merely providing the illusion of universal primary care.
    Also, it is not unreasonable for doctors to be asking “Whats in it for me?”. If doctors are to be increasingly treated like public servants, they will demand benefits, paid sick days, maternity leave, coverage of overhead and limits on expected work hours per week. These requests aren’t unreasonable but will likely get very expensive.

  3. Hoda

    There is not doubt that a strong primary care system saves health care dollars and keeps people healthier down the line. However, a pressing issue that will effect the implementation of these recommendations is that of Nurse Practitioner salaries. There is a 20% vacancy in NP positions in the community due to a wage freeze for the past 9 years. NPs are taking higher paying jobs in tertiary and LTC. At a time when strengthening primary care has been named a priority our health care system has become a revolving door. Fair and equitable compensation is necessary to ensure that primary care providers stay in the community to Provide access to primary care!

    • Vera

      I don’t want to see a NP, I want a doctor who can prescribe all meds and has more education. Are we now going to be forced to see a NP in a province with no private options. I really don’t care about your wage freeze, I will have a non indexed pension and lost my job at 50 so the amount will be half of what I would have got if they didn’t ship my job to Bangalore (big bank). If you don’t like the pay go back to school and be a doctor.

  4. Elizabeth Rankin

    I’d vote if the most important category hadn’t been been overlooked…PATIENTS!

    • Alex

      I agree. One of my biggest frustration with my colleagues is that we don’t advocate for ourselves and our own wellbeing. For that reason, the government is able to trample us without repercussion. It is only once things get so bad, that doctors leave and patient care becomes negatively affected, that the government reverses its attack on doctors. They save a few bucks in the meantime.
      We can criticize teachers all we want. But you can’t deny that throughout our economic ups-and-downs, the quality of our education system has remained pretty good. That is in large part due to teachers ferocious self-advocacy.
      The miserable state of the healthcare system in the Rae Days and Harris era would not have occurred if doctors had stood up for themselves, rather than packing up and leaving.

  5. Chris

    This sounds like a workable plan to overcome some tremendous inertia in primary care. This appears to be a sound directional charter. Could we actually bring this to implementation, even in a few test regions – northern, rural, urban? Could we do this within one year? Could we please stop talking about changing primary care and just do it?

    My city has about 120,000 people. There is no after-hours care, and the one walk-in clinic has all its work set by 10:00 a.m. If you show up later, too bad. So you go to the hospital. The hospital has its issues, but has implemented patient flow improvements so that wait times are often better than feared. That’s good, but primary care is not primarily a hospital’s job. The access issue is far from solved.

    After the teacher bargaining fiasco, I hope our government will show more integrity and resolve to make changes that demonstrably benefit citizens and patients. More money should not be necessary. Wouldn’t it be wonderful to read in a 2020 Commonwealth Report that our access times are in the top half of our peer countries and that public confidence in our system has never been higher?

    This is not an issue that needs more study. It needs leadership.

    • Alex

      Team based primary care already exists. It has been around for some time and was the pet project of the government a while ago. The Family Health Team/Organization is a team based model that already exists. It provides more accessible, and some would argue, higher quality care that the lone “fee-for-service” doctor.
      Most new graduates are trained in team based models. Visits are less rushed. You can truly focus on the patient’s needs rather than churning through patient encounters as fast as you can, to generate the billings needed to cover overhead and student loan payments. Most new graduates desperately want in to the already existing team based models.
      There is one major problem. The cost-per-patient is marginally higher in team based care than in fee-for service. As much as the government complains about FFS, it provides dirt cheap “care”. The government will not allow new grads into the existing team based models.
      This report is great. But the government will pick and choose what it wants, and implement these “Patient Care Groups” to give the illusion of universal primary care, by rostering to many patients, to far too few doctors. “Free’ health care for all.

    • andrea

      chris, thank you for a reasoned response to some of the assessments and comments. With the leadership you speak of we could restructure much of the current bureaucracy and the predicted added bureaucracy levels actually have functional local citizenry involvment as opposed to token selected representation at LIHN pow wows, and many of the costs to the overall health care budget will diminish because of better primary care in the more effective place with more effective teams and generally better health indicators for the population. currently administering up to 5 different primary care models is very expensive, ineffective and divisive.

  6. Lee Green

    The report will cause a lot of excitement because it represents major change, and change is always unsettling. In terms of content nothing radical though, it’s a quite sensible set of recommendations modeled on what’s already done in health care systems that deliver better results for patients at lower cost than is the case in Canada. If that’s what we really want, better patient outcomes at lower cost, there’s not a lot of mystery about what to do. As Keynes pointed out, “The difficulty lies not so much in developing new ideas as in escaping from old ones.” We have some escaping to do.

  7. Peter G M Cox

    These proposals appear to make eminent good sense – IN PRINCIPLE – but I share Alex’, Elizabeth Rankin’s, Mike Toth’s and Arianna Tetley’s concerns –

    In my experience and from what I’ve read in this and other forums, too many of our doctors and nurses are already “overstretched” and, if the objectives of this report are to be met, it will NOT be by making them take on (even) more patients and working longer hours. (We already employ far fewer doctors and fewer nurses per capita than western European countries and, even so, graduate fewer doctors per capita than they do. The results are high stress levels and too much staff turnover – not what I, as a potential patient, contemplate with equanimity!) The objectives of this report CAN only be met by providing sufficient medical professionals to cope with the patient load.

    Proposing another layer of administration also fills me with dread! If we can’t afford sufficient doctors and nurses (and hospital beds), how on earth can we finance another administrative function? (Canada spends roughly as much per capita on healthcare as the European countries referred to above – but, according to the OECD, less per capita than any on patient care and more on pharmaceuticals, “medical goods and services” and “collective services”.)

    The objectives of this report are laudable but the proposed strategy needs to be dovetailed with a much broader strategy for our entire healthcare system. Healthcare is what I would describe as the “ultimate” customer service industry. (It caters to our most fundamental NEED – health and survival.) It should be focused on “customer” (patient) service and ensuring that there are sufficient, competent, “frontline staff” and resources to make this possible. In (private sector) business this means emphasizing “customer service” so as to achieve this objective – and minimizing materials input costs and administration. I’m sure the European countries I refer to have their problems but they are addressing them far more successfully than we are.

  8. Arnold lurie

    In our system where there is absolutely no patient accountability and health care is perceived as being”free”, abuse of the system will just continue.
    Regardless of the type of reform imposed unless there are some rules applied to unrestricted patient access nothing will change.
    There are so many unknowns such as practice size, minimum hours to work, patients needed to be seen in a day, this will be a nightmare

  9. Scott Wooder

    Something desperately needs to be done to improve the Primary Care “system”. We need to be careful that we don’t yield to the temptation to accept change for the sake of change.
    The missing piece from the Expert Panel report is how the high level suggestions get implemented. We need to talk to providers and patients about what a new system should look like.
    Given the poor relationship between Government and physicians and the lack of trust we need to repair the relationship, re-establish trust and start talking.
    I’ve spent a lot of time in the past 15 years engaging physicians. It can be difficult but it is worth the effort.
    Engagement will not come through unilateral action where all the power rests with Government.

  10. Dr Merrilee Fullerton

    “The PCGs are in fact a layer of administration – and that’s just what’s needed, because there is none now, argues Price”

    Oh my.

    Watch primary care costs soar with this kind of silliness.

    Unbelievable.

    Watch…more funding for administration, squeezing of providers, and no change in patient health outcomes.

    Just watch.

    • dr peter hill

      this has nothing to do with patient care, or even costs. it has everything to do with reducing family docs from autonomous patient advocates to government employees. its about control.

      costs will increase because bureaucracy will expand, and patients will lose their primary care advocates. wait times will go up, and no medical students will want to go into it so well have to settle for questionable foreign trained physicians or nurses.

      there is already an index case for this, and thats pathologists. see how theyre doing. lots of quality issues precisely because they have no control over their practices and must march to the tune of administrators or risk being replaced by a more servile, less advocating person. and just as above, no medical students go into pathology so the bar is set very very low.

    • Chris

      This kind of fear-mongering is not useful. There’s certainly an argument for more and better administration to measure the outcomes of the high variability in physician treatments. Physicians need to help control system costs and start making decisions that consider economic analyses. Some professionals need “squeezing”, and some should be squeezed right out of the system because they do more harm than good. Certainly not all MDs are “great”, or even above average.

      Better measurement and management should allow us to respect and provide sufficient autonomy for good physicians and improve the others. Weaker physicians may fear this, but most won’t. Patients will welcome greater accountability from providers and better treatment decisions and outcomes.

      • andrea

        chris, again thanks for cutting through some of the less evidence based comments with your succinct assessment. I would like to see patient grouo representative aid in evaluating more than just the performancs indicators used for that bunch of adminstrators and policy makers. Patient satisfaction And Wellbeing reports also are required. Such evaluations might also force honest community driven care and what I call “right thing” accountability.

      • Alexander Bardon

        “Physicians need to help control system costs and start making decisions that consider economic analysis” You certainly must appreciate the economic position physicians are in. Because physicians are “free”, this creates an artificially high demand for physician, even the not so good ones. Physicians have no control over this. It’s the Canada Health Act. The artificially high demand for physician services drives the physician service budget up… and physician workload. As the physician funding cap is reached, the funding each physician receives for providing care to a patient is continuously being “squeezed” lower, while overhead, inflation etc inevitably increase. This negatively affects the quality of care physicians can provide to each individual patient. The quality of care a physician can provide to a patient, is largely dependent on how much time the physician spends has to spend with the patient. Ask any doctor or patient, no one benefits from rushed visits. Why then, is this our aim to force doctors to take on more patients than they can already handle?
        The physician-patient ratio in Ontario is pathetic. This has to be addressed. The governments posturing and actions are scaring doctors away. Regardless of how physician services are administered, quality of care will suffer if the doctors are not funded in a way that allows sufficient doctor-patient facetime. Things are already too rushed as it is.

  11. you cant handle the tooth

    Why don’t we see these access problems with dentists?

    For decades I have watched governments come up with different schemes to improve the “system” only to make it worse.

    There was a time when both doctors and dentists ran efficient and accessible practices. They also could sell these practices for a significant “goodwill” fee. Now a dentist can still their practice for a significant goodwill payment while a doctor can’t give it away. Now a 2 hour wait is often considered normal in a doctor’s office but it would never be tolerated in a dental office.

    When will we learn from the Dentists?

    • CC

      Dentists are not paid by public funding for one thing. They also are not required to provide care to a patient more than maybe once per year. You can’t compare dentists to doctors here.

      Yes there was a time when Doctors ran efficient and accessible practices, however back then there was more funding, and less people. People were also IMO more conscious about their health. Kids played outside til the street lights came on, they watched maybe 5-6 hours of TV per week compared to 5-6hours per day now.

      • Vera

        We could have private pay and personal choice, now that’s a thought. Quebec allows it. Doctors “back then” worked harder, longer hours, did house calls, it wasn’t because there were fewer people. My doctor as a kid came to the house to check all the kids for measles and chickenpox. He probably worked 70 hours a week.

      • You cant handle the tooth

        CC,

        Let me make a major correction for you, the correct statement should be
        “dentists are not UNDERpaid by public funding for one thing”.

        for example check the Ontario Medical Association (OMA) schedule of fees vs. what the ontario government (OHIP) actually pays. The OMA schedule has kept up with inflation whereas t OHIP has not, it is paying less than half of what it should be to keep up with inflation.

        Dentists don’t have this problem.

        Governments continue to come up with different schemes to make things more “efficient” and in their pursuit of magical thinking. All that gets accomplished is that more money goes to administration and never ending consultant fees rather than going back to patient care.

        Dentists are guided by the invisible hand of innovation to survive in their competitive environment. Doctors are at the mercy of well meaning people and governments who artificially restrict the the efficiencies of “the invisible hand”

  12. Neena

    I agree that the health care system needs to be reformed however, I do not agree with another bureaucratic layer. What are the LHINs for? Are they not here to integrate the health care system. Why would we need patient care groups? CCACs, FHTs, Hospitals and Pubic Health should all be entities under the LHIN with the LHIN setting accountability indicators, and engaging and integrating stakeholders. Public Health Ontario can provide the evidence and best practice in terms of health promotion. There is too much duplication in the system. It needs to be “managed” by one entitiy…the LHIN.

  13. Ally

    Why can’t we follow the examles of other countries, where the Health Care is so much more accessable?
    Why do we have to be so short sited and continuously create more problems for patients and health practitioners by creating even more “layers of bureaucracy” in the primary care sector?
    It feels like that is gonna be the next “old-new mirracle, but wrapped in a shiny paper”.

  14. Chris

    Even to come to a vision of PCGs and family medicine reform without a dialogue with it’s physician members at large is suspect. Though Dr. Bell states the reform will not involve changes in physician compensation, the language of the document certainly doesn’t rule out physician funding flowing through the PCGs. The only reason one can imagine this would occur is to provide capitation at arms length from the MOHLTC. Given the current climate of broken relations between the OMA and MOHLTC how could physicians thing any differently?

    Assigning services based on population will not always result in equitable access to services. This will favour academic hospitals and cities over health care for rural populations. The later group often have worse health outcomes because of scarcity of immediate health care access. The current Liberal government made the same arguments when Stephen Harper disbursed provincial health care transfers based on population figures. The east coast provinces saw their transfers decline.

  15. Vera

    Except what if the patient will not be accepted by a doctor. I refuse to have cancer screening so cannot get a primary care doctor. All my care is done by a walk-in clinic or online via Google. Family doctors will not accept a patient who refuses pap smears, mammograms or the FOBT test unless you are over 74 when screening stops. For my migraines I found a walk-in dr that will prescribe me the medication without forcing cancer screening as a prerequisite as the family team doctors do. So good luck with that. You will force me to go to Dr X who will force me to get tests I refuse to get. Like that will really work. The minute this is implemented is the day I move to Alberta.

    • Vera

      I’m really tired of being used as a doctor’s cash cow, and treated like a baby with no rights to make my own decisions. Price-Baker will try to get rid of walk-ins which means no health care for me. Don’t tell me I must go to Dr. X or Y and they hate me as a patient. It took me years to find a walk-in doctor that we get alone well together and I can get my migraine medication without a mammogram first. The Supreme Court ruled that we have informed consent laws but you would never know it going to the average “family health team”. Cancer Care Ontario makes Orwellian laws that nobody knows about and get away with it – no opt outs or you are red flagged as being non compliant.

  16. Martha

    Changes to primary care should be directed to an end goal of increasing the flow of information between the entire team of care providers. The current system is too fragmented and disconnected to provide the most efficient and informed care to the patient. One physician in one location cannot provide for all of the care needs of all of their patients all of the time, so the system has to acknowledge that many different physicians provide care to the same patient. How much better would that care be if they all had access to the same information regarding the patient’s medical history and test results?

    Moving towards team based models offer better connectivity between all of the various care providers, which allows for increased access, aggregation and analysis of patient medical information, ultimately leading to better patient outcomes. Analyzing data over various sub groups can better detect emerging epidemics and effectiveness of treatments, which increases overall health and medical knowledge. Physician billing data analyzed on group levels can better detect anomalies that could be indicative of irregular or fraudulent activity.

    The FHO/FHT models are a step in the right direction, and should be further developed and built upon. The Access Bonus model would better incentivize physicians to increase care if they were held accountable for negativity, but it should also take into account the increase of availability of walk in clinics in urban settings. If those clinics, emergency rooms and FHO groups were all under the same umbrella, such as in the PCG model, they could better share the responsibility of caring for the same group of patients.

  17. Ravinder Ohson

    I agree on more accountability: using the choosing wisely guidelines, accountability on the part of the patients as well.

    I also feel the there should be a cost included on tests that are ordered. This will help patients realize getting a ‘complete test’ done every year is not without cost.

    Perhaps the most cost saving to be realized will be from a unifying EHR that will connect hospitals, doctors, pharmacist etc. There is a loss of resource every time a test gets reordered.
    Alberta has done it, so why not Ontario?

  18. J. Andrews

    Anyone ever heard of “Consumers”? “Users of the System”? “Canadian Citizens”? “Communication?” “1984” “Civil Rights”? “Provincial Election”? “Voters”? “Cost of the Overhead? The Armies of Accountants, Auditors, Tax Auditors, Data input clerks, systems designers, “17 different ways Doctors can be paid –(Kelly Grant Globe&Mail15/2/15) — maybe the Mastoden is too big for the Alligator to swallow in one gulp — maybe we should start it off with, say, smaller units of food? that is, numbers of lesser goals, permitting consultation and adaptation to initially unperceived difficulties…?

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