Primary Health Care in Canada: Systems in Motion

Abstract

Context:During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada.Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support.Conclusions: Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert.

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

“…Other provinces introduced chronic care incentives while making simultaneous changes to payment systems and primary care service delivery models. 6,7 British Columbia's Complex Care Initiative offers an annual $315 payment to physicians who accept responsibility for the provision of comprehensive, continuous, guideline-informed care for a patient with 2 or more targeted chronic conditions. 8 This was implemented in 2007 within the existing fee-for-service payment system, and with no new support for team-based care or other service delivery models.…”

Impact of payment methods on professional equity of physicians

“…Indeed, strengthening primary care has been recommended as a strategy to improve health of populations [32] . In Canada, several provinces are engaged to change primary health care, promoting inter-professional work, team-based care, and alternative payment arrangements [33] . Since income disparities are present among medical specialties [19] , APPs could be more supportive of primary care reforms by the enhancement of professional equity-adjusting tangible and intangible rewards-of FPs.…”

Programa De Saúde Da Família No Brasil: Reflexões Críticas À Luz Da Promoção De Saúde

“…(37) No Canadá, o PACS foi implementado entre os anos 1980 a 1990. Avaliações das transformações dos papéis dos agentes comunitários em saúde ao longo do tempo, têm sido realizadas, tanto no Canadá, (38) como no Brasil. (39) Estas análises críticas tem demonstrado que o sucesso do PACS depende de múltiplos fatores e são aplicados à realidade e contextos próprios onde estão inseridos.…”