Primary Health Care in Canada
Improvements to primary health care (PHC) can potentially increase the health of Canadians while lowering health care costs. Research has shown that delivering PHC services in teams has been positively associated with better health outcomes, particularly in respect to chronic disease management, preventive care, and aging populations. We also know that interdisciplinary teams offer better services in terms of quality, coordination, continuity and comprehensiveness. In addition, non-traditional incentives, such as pay-for-performance programs, can contribute to the achievement of the same goals.
Interdisciplinary Primary Health Care Teams
The move toward delivering primary health care using interdisciplinary teams is spreading throughout Canada. Many provinces have introduced team based models of delivery into their system. Examples include:
Province Team based model
- British Columbia: Primary Health Care Organizations
- Alberta: Primary Care Networks
- Saskatchewan: Primary Health Care Teams
- Manitoba: Physician Integrated Network
- Ontario: Family Health Teams, Community Health Centres, Primary Care Networks
- Quebec: Family Medicine Groups
- Nova Scotia: Family Health Teams
- Prince Edward Island: Primary Health Care Networks, Family Health Centres
The question remains how best to structure payments and management of interdisciplinary teams to achieve health system goals. The academic literature is underdeveloped in this area. Evaluations of team remuneration and management models specifically have not been found. Typically, these models develop organically and/or are based on other existing models. They are not based on evidence of success.
Pay-for-Performance in Primary Health Care
Pay-for-performance (P4P) is used here to mean all payments to PHC providers that are made in addition to their regular base remuneration. For example, payments received for achieving specific targets at the population level, or payments received for completing cycles of care for individual patients.
These two topics are not mutually exclusive. In Ontario, for example, P4P programs are only available to PHC physicians who participate in one of the team delivery models. The Manitoba PIN has introduced some elements of P4P, British Columbia has a set of P4P programs, and those have been copied, to a large extent, by Nova Scotia.
The academic literature on the success of P4P programs is scant, and only one Canadian study has been found. Similarly to the question of paying and managing teams, we know very little about what works and what does not work in P4P programming.