ICES | Primary Care Models in Ontario English - page 35

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10
These findings provide several implications
for policy.
1 /
CHC Model:
The CHC model appears to
play an especially important role in Ontario
for disadvantaged populations. A continuing
influx of immigrants to Ontario and growing
income inequalities suggest an increasingly
important need for care in these populations.
Other research has found that health care at
CHCs is associated with better chronic
disease management and geriatric care,
more comprehensive care and greater
community orientation.
The current
analyses find that CHC care is also associated
with lower than expected ED visits.
2 /
Capitation Rates:
FHGs and ‘Other’
models care for a profile of average Ontarians
and also have lower than expected ED visits.
The capitation models (FHN, FHO, FHT) serve
more advantaged Ontarians with a lower
illness profile and have higher than expected
ED use. Adjusting capitation rates to account
for health care needs could help to bring
more high needs patients and more high
needs practices into these models. Currently,
FHGs that switch to capitation can expect to
lose income
in large part due to having
sicker than average practices. This barrier to
joining capitation models is also a barrier to
joining FHTs because only capitation models
are allowed. This situation would likely
change with appropriate capitation
3 /
Payment Incentives
: The current access
bonus payment for avoiding outside primary
care use appears to be the wrong incentive to
remedy Ontario’s very high use of hospital
as it does nothing to discourage ED use.
As well, many practices receive little or no
access bonus and this often occurs in settings
with many alternate sources of care, such as
major urban centres. Practices in those
settings that provide excellent access receive
the same treatment (no bonus) as those that
fail to provide access. The access bonus may
also act as a deterrent for providers in
different groups and models to work together
to provide timely and after-hours access to
members of their community. Another reason
to re-examine the access bonus is that
access to timely care and after-hours care
has not improved in recent years despite an
increasing number of Ontarians having a
family doctor.
If payment incentives for
access remained a desirable feature of
primary care models, the current access
bonus could be redesigned to incorporate ED
visits, to reflect observed versus expected
outside use, or to be based on the availability
of same-day and after-hours appointments. A
more person-centred approach would be to
base incentives or other forms of expectations
or accountabilities on patient-reported access
to care. For example, access questions on the
English General Practice Survey are used for
practice-based pay-for-performance, with
adjustment for patient characteristics.
that setting, practices are rewarded for
offering both timely appointments and for
offering the ability to book ahead of time.
Survey results are publicly available at the
practice and regional level.
4 /
ED Use:
Ontario’s high rate of ED use is
also an important policy target. Enforcement
of existing after-hours commitments has
been problematic but is now receiving greater
Ministry attention.
Further expansion of
hours, pooling of resources across groups
and models of care to meet community
incentivizing of home visits, and
office redesign to ensure timely access to
could all play important
roles in reducing ED use.
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