Primary care models in Ontario serve vastly different patient populations in this province. New research done at the Institute for Clinical Evaluative Sciences (ICES) examined the different models of primary care and how each serves Ontario’s most vulnerable populations.
This study examined patients in: Community Health Centres (CHCs, a salaried model); Family Health Groups (FHGs, a blended fee-for-service model); Family Health Networks (FHNs, a blended capitation model); Family Health Organizations (FHOs, a blended capitation model); Family Health Teams (FHTs, an inter-professional team model composed of FHNs and FHOs); ‘Other’ smaller models combined; as well as those who did not belong to a model.
“We really need to understand the advantages and disadvantages of the many models used in Ontario. Very little work has been done to understand value for money in Ontario’s primary care models and such studies are long overdue,” says Dr. Rick Glazier, principal investigator of the study and Senior Scientist at ICES.
The study examined primary care models in Ontario from April 1, 2008 to March 31, 2010 and found:
- Compared with the Ontario population, CHCs served populations that were from lower income neighbourhoods, had higher proportions of newcomers and those on social assistance, had more severe mental illness and chronic health conditions, and higher morbidity and co-morbidity. In both urban and rural areas, CHCs had emergency department (ED) visit rates that were considerably lower than expected.
- FHGs and ‘Other’ models had socio-demographic and morbidity profiles very similar to those of Ontario as a whole, but FHGs had a higher proportion of newcomers, likely reflecting their more urban location. Both urban and rural FHGs and ‘Other’ models had lower than expected ED visits.
- FHNs and FHTs had a large rural profile, while FHOs were similar to Ontario overall. Compared with the Ontario population, patients in all three models were from higher income neighbourhoods, were much less likely to be newcomers, and less likely to use the health system or have high co-morbidity. ED visits were higher than expected in all three models.
- Those who did not belong to one of the models of care studied were more likely to be male, younger, make less use of the health system and have lower morbidity and co-morbidity than those enrolled in a model of care. They had more ED visits than expected.
“Ontario’s primary care models serve different populations and are associated with different outcomes. The largest current models of care have been costly but haven’t improved the population’s access to care, which was a key aim,” says Glazier.
The authors add that 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 consideration.
Author block: Richard H. Glazier, Brandon M. Zagorski and Jennifer Rayner.
The report “Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Department Use 2008/09 to 2009/10” is an ICES Investigative Report published March 6, 2012.
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.
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