ICES | Primary Care Models in Ontario English - page 37

Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use, 2008/09 to 2009/10
Ontario’s primary care models serve different
populations and are associated with different
outcomes. A move away from fee-for-service
reimbursement may be desirable for a high
functioning health care system, but how
alternate payment mechanisms are
structured appears to matter a great deal.
The largest current models of care have been
costly but have had limited impact on
population access to care, which was a key
aim. The capitation and team models that
have received the most new resources are
looking after relatively advantaged groups
and are associated with higher than expected
ED visits. The payment and incentive
structures underlying these models therefore
require re-examination. The CHC model
offers an attractive alternative in many
respects, but CHCs serve a different role than
the other primary care models and are
resourced and governed quite differently.
Where they fit within primary care in Ontario
should also be the subject of further policy
So far, little work has been done to
understand value for money in Ontario’s
primary care models and such analyses are
long overdue. Ontario’s diversity of primary
care models, if properly evaluated, can
provide a wealth of information for policy
makers. Decision-makers in Ontario and
other provinces and countries are grappling
with how to make health systems more
effective and efficient. Ontario has a unique
opportunity to redesign primary care by
understanding and applying evidence about
its many models of care. It is hoped that this
report may help policy makers to understand
how Ontario’s primary care models relate to
the types of patients served and the outcome
of ED visits, with a view towards re-orienting
existing resources and future investments.
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