Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?

Abstract

BackgroundOver the past decade, in the province of Quebec, Canada, the government has initiated two consecutive reforms. These have created a new type of primary healthcare – family medicine groups (FMGs) – and have established 95 geographically defined local health networks (LHNs) across the province. A key goal of these reforms was to improve collaboration among healthcare organizations. The objective of the paper is to analyze the impact of these reforms on the development of collaborations among primary healthcare practices and between these organisations and hospitals both within and outside administrative boundaries of the local health networks.MethodsWe surveyed 297 primary healthcare practices in 23 LHNs in Quebec’s two most populated regions (Montreal & Monteregie) in 2005 and 2010. We characterized collaborations by measuring primary healthcare practices’ formal or informal arrangements among themselves or with hospitals for different activities. These collaborations were measured based on the percentage of clinics that identified at least one collaborative activity with another organization within or outside of their local health network. We created measures of collaboration for different types of primary healthcare practices: first- and second-generation FMGs, network clinics, local community services centres (CLSCs) and private medical clinics. We compared their situations in 2005 and in 2010 to observe their evolution.ResultsOur results showed different patterns of evolution in inter-organizational collaboration among different types of primary healthcare practices. The local health network reform appears to have had an impact on territorializing collaborations firstly by significantly reducing collaborations outside LHNs areas for all types of primary healthcare practices, including new type of primary healthcare and CLSCs, and secondly by improving collaborations among healthcare organizations within LHNs areas for all organizations. This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs.ConclusionHealth system reforms aimed at creating geographically based networks influenced primary healthcare practices’ both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare.

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Providers’ Perspectives on the Implementation of Mandated Local Health Networks for Older People in Québec

“…The administrative merger of public organisations was the main mechanism the government of Québec chose to promote integration of health and social services [343536]. These Health and Social Services Centres were mandated by government to create Local Health Networks through formal and informal inter-organisational agreements [3738]. Various Local Health Networks addressing the needs of different sub groups of the population living on their territories were developed such as the Local Health Networks for Older People [39].…”

Moving regional health services planning and management to a population-based approach: implementation of the Regional Operating Model (ROM) in Victoria, Australia

“…Population-based planning is based on the identification of determinants of health to promote equitable access to services and health outcomes (World Health Organization 2008). The literature points to varying methods, policies and processes, across countries and regions, to base health planning on population approaches, and highlights tensions and challenges in embedding such a transformation in systems (Dubbs et al 2004;Carter et al 2007;Levesque et al 2011;Breton et al 2013).…”