Ontario's experiments with health care reform

CALGARY, April 24, 2014 /CNW/ - Over the past 15 years Ontario has been experimenting with new models for compensating physicians and formalizing their relationships with patients. The goal is to improve service quality and ease of access. A key motivation for these changes is preventive care and chronic disease management, especially given population aging. Has Ontario achieved its objectives? And, what can other provinces learn from Ontario as that province takes the lead in this aspect of health care reform?

In a paper published today by The School of Public Policy, authors Arthur Sweetman and Gioia Buckley outline and evaluate the province's move away from traditional fee-for-service towards alternative payment models for primary care physicians (i.e., family physicians/general practitioners).

Traditional fee-for-service pays physicians for each activity performed according to a negotiated schedule of benefits. Fee-for-service is commonly associated with the overprovision of some services and is not as well suited to funding the delivery of preventive health care, and care for chronic diseases, as are other payment models. Between 2000 and 2013 the percentage of primary care physicians remunerated by traditional fee-for-service dropped from roughly 95% to about 36%.

The new blended models of physician pay include different combinations of capitation, pay-for-performance, and fee-for-service. Capitation means physicians in family/general practice receive a single payment for providing a "basket" of services to a particular patient for a fixed period, for example a year, regardless of the number of services provided. Pay-for-performance includes a set of bonus and incentive payments for, for example, achieving specific targets. It typically focuses on preventive care and managing chronic conditions.

Associated changes include a push towards group practices, increased after hours care, and "rostering" where patients and their family physicians sign agreements formalizing a one-to-one relationship. Rostering has several benefits, including, for example, facilitating the proactive delivery of vaccinations, flu shots and Pap smears.

Although the system is continuing to evolve, Sweetman and Buckley find that Ontario's alternative payment schemes show mixed results to date. Not all efforts are working as expected. They also identify a need to quantify the impacts of these new models on downstream health-care costs, such as prescription drugs and diagnostic tests.

The authors emphasize that the financial commitment shown by the government to experiment with alternative funding models and alternative patient-physician relationships needs to be supported by ongoing evaluations of their effectiveness.  These evaluations should include input from physicians, patients and the public payer of physician services. Ontario's experiments have the potential to inform other provinces of what approaches are most successful and so can contribute to Canada-wide improvements in publicly-provided health care.

The report can be found at http://www.policyschool.ucalgary.ca/?q=content/ontarios-experiment-primary-care-reform

SOURCE: The School of Public Policy - University of Calgary

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