Table 1

Ontario's main primary care models in 2005/2006.

Community Health Centre (CHC)

Fee for service (FFS)

Family Health Network (FHN)

Health Service Organization (HSO)


Traditional

Fee for Service

Family Health Groups (FHG)1


Year introduced

1970s

-

2004

2001

1970s


Group size

Groups practice - Unspecified size

1 Physician

Minimum 3

Minimum 3

Minimum 3


Physician remuneration

Salary

FFS

FFS and incentives

Capitation2 with a 10% FFS component, and incentives

Capitationb

and incentives


Patient enrolment

Required

No roster size limit

Not required

Required

No roster size limit

Required

Disincentive to enrol >2,4003

Required

Disincentive to enrol >2,4003


Access

No specified requirements

No specified requirements

THAS4

Extended hours5

THAS

Extended hours5

Access bonus6

THAS

Extended hours5

Access negation7


Multi-disciplinarity8

Significant

None

None

Some

Some


Assistance for Information Technology

Some

None

None

Yes

None


Objectives/Priorities

Responsiveness to population needs, multi-disciplinarity, prevention, focus on underserved, equity community governed

-

Accessibility

Accessibility, comprehensiveness, doctor-nurse collaboration, use of technology

Responsiveness to population needs, multi-disciplinarity, health promotion, cost effectiveness


1Late in 2004, the Ontario Ministry of Health (MOH) created a new model of care, the FHG, to which FFS practices could transition. Family Health Groups (FHG) needed to comprise three or more family physicians practicing together. These physicians need not be located in the same physical office space, but must be within reasonable distance of each other. FFS practices converted to this new model quickly, so that by early 2006 most FFS practices had become FHGs, and it became evident that the great majority would transition by the year end.

2Under capitation remuneration, family physicians received a fixed monthly fee per patient enrolled, independent of the number of visits made to the practice by that patient. The capitation fee is based on the enrolled patient sex and age. FHN physicians receive an additional 10% of the FFS structure for each visit. The later is principally intended to allow for a better monitoring of the services delivered.

3The base capitation rate is reduced to 50% for patients enrolled to a provider with a practice size exceeding 2,400

4 THAS = Telephone Health Advisory Service - A 24 hrs/7 days a week patient telephone advisory service available to enrolled patients.

5Each physician is required to provide at least one 3 hour session outside regular hours (evening/week end) per week (up to 5 sessions per group/network/organization)

6 An incentive bonus that is reduced in relation to the number of visits patients make to non-specialists outside the FHN.

7 A penalty incurred from the capitation fee for visits patients make to non-specialists outside the FHN.

8 Multi-disciplinarity refers to the presence of allied health workers (e.g. dietician, social worker, and pharmacist), excluding nursing staff, but including nurse practitioners.

Informed by the Ontario Medical Association's "Comparison of Models" table - https://www.oma.org/PC/PCRComparisonJan0807.pdf webcite (PCRComparisonJan0807.pdf)

Dahrouge et al. BMC Public Health 2010 10:151   doi:10.1186/1471-2458-10-151

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