ICES | Primary Care Models in Ontario English - page 19

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10
Primary Care Model Profiles
The primary care models investigated in this
report had sociodemographic, morbidity and
comorbidity and ED use profiles that were
quite different from each other. Based on the
study findings, a brief profile of each model
can be summarized as follows:
Community Health Centres (CHCs)
are
distinct from other primary care models in
Ontario in their focus on the needs of specific
populations, salaried employment
arrangements, orientation to outreach and
health promotion and governance by
community boards. Although a few FHTs have
community governance, those community-
governed FHTs could not be included in this
report and are the focus of ongoing
investigation. CHCs had populations that were
slightly younger than other models and they
were more likely to be rural than the
population of Ontario. The remainder of the
sociodemographic profile of CHCs was
striking and distinct from the other models.
CHCs served populations that were from
lower income neighbourhoods. They also had
a higher proportion of newcomers to Ontario
and a higher proportion on social assistance.
CHCs had the highest proportion of people
with severe mental illness, asthma and
chronic obstructive pulmonary disease, as
well as a high level of morbidity and
comorbidity. In both urban and rural areas,
they had ED visit rates that were considerably
lower than expected.
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ICES
Family Health Groups (FHGs)
constitute the
only formal primary care model that has the
majority of physician reimbursement through
fee for service. They include small capitation
payments and many of the same commit­
ments and incentives as the other primary
care enrolment models. FHGs were almost
all (97%) urban and had a socio­demographic
profile very similar to that of Ontario as a
whole but with a higher proportion of
newcomers—likely reflecting their urban
location. The morbidity and comorbidity
profile of FHGs was also similar to that of
Ontario as a whole. Both urban and rural
FHGs had lower than expected ED visits.
Family Health Networks (FHNs)
were the
first generally available primary care
enrolment model. They have blended
reimbursement with a large capitation
component, along with partial fee-for-service
payments (10% during the study time period)
and a variety of obligations and incentives that
are similar to other patient enrolment
models. FHN was the smallest model
examined and had a large rural
representation (36% of FHN patients). FHNs
had a high proportion of high income patients,
especially in rural areas, and a relatively low
proportion of low-income patients. FHNs
looked after few newcomers. FHNs had the
lowest proportion of patients with serious
mental illness and relatively low proportions
with chronic conditions, morbidity and
comorbidity. ED visits in FHNs were higher
than expected in both urban and rural areas.
Family Health Organizations (FHOs)
were
initially introduced as a way to harmonize the
Primary Care Networks and Health Service
Organizations with other patient enrolment
models; and the FHO model also became
available to all primary care physicians in
Ontario. FHO was very similar to the FHN but
had a larger basket of services and a higher
capitation payment rate. It rapidly gained
popularity and by 2010 had become the most
common patient enrolment model. Many
FHTs are also FHOs but those practices are
grouped with FHTs in this report. FHOs had a
low proportion of patients from low-income
neighbourhoods and in urban areas they had
the highest proportion of any model of
patients from high income neighbourhoods.
They also looked after few newcomers. FHO
was similar to FHN in its chronic condition,
morbidity and comorbidity profile and had
higher than expected ED visits in urban areas
but lower than expected in rural areas.
Family Health Team (FHT)
is an inter-
professional team model and not a funding
model. The FHTs examined in this report
were either FHNs or FHOs but were
considered only as FHTs in this report. In
terms of sociodemographics, FHTs had a high
rural representation (17%). They were very
similar to FHNs and FHOs in socio­
demographic characteristics and they were
also similar in the prevalence of chronic
conditions and in morbidity and comorbidity.
They had higher than expected ED visits in
urban and rural areas.
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