Table 2 Summary of selected primary care reforms in the four study regions
British Columbia | |
Funding model | FFS funding accounted for 82% of payments to primary care physicians [19, 20] |
EMR | By 2016, the majority of primary care practices used EMRs [8] |
Integration with regional entities | FPs located within the same geographic region could be linked to a local Division of Family Practice that works with regional health authorities to provide services to meet the specific needs of their respective communities [21] |
Interdisciplinary teams | Interdisciplinary team-based care was rare in community-based practice, despite being an ongoing focus of the “provincial vision” for primary care [22, 23] |
Number of FP in a group | The majority of FPs in the province practiced in small group physician-owned and operated community practices that were “relatively isolated from other doctors and the larger healthcare system” [24] |
Ontario | |
Funding model | Reforms from the 2000s encouraged wider use of capitation with additional FFS and/or bonuses for targeted services for formally enrolled patients. Individual organizational models varied by the basket of services funded by capitation versus FFS payment [2, 5, 25]. By 2019, 44.8% of clinical services were paid by FFS [19] |
EMR | Funding was available for FPs to implement EMRs [8] |
Integration with regional entities | Local Health Integration Networks provided limited coordination and planning in the primary sector. In the fall of 2019, Ontario began the process of forming regional referral networks for hospital, medical, and community care services (called Ontario Health Teams), but had not fully implemented them when the COVID-19 pandemic was declared in March 2020 |
Interdisciplinary teams | Funding envelope for Family Health Teams included funding for other health professionals and administrative personnel [8] |
Number of FP in a group | Funding reforms required forming groups with 3+ FPs [2] |
Nova Scotia | |
Funding model | In 2019, 41.3% of clinical payment in family medicine was billed through FFS [19]. Alternative payment consisted primarily of academic payment plans |
EMR | The province incentivized EMR adoption using a fee code in the master billing agreement [3] |
Integration with regional entities | In the capital region, NS created a District Department of Family Practice to strengthen primary care in the region |
Interdisciplinary teams | Since the early 2000s, the province promoted nurse practitioner-led practices [26], collaborative FP and nurse practitioner, and FP registered nurse group practices [3]. The province introduced the Health Home Model in 2015 [27], consisting primarily of small teams of FPs, registered nurses, and/or nurse practitioners [3] |
Number of FPs in a group | Primary care was largely delivered by FPs in solo or group practices, through collaborative family practice teams, or Community Health Teams [4] |
Newfoundland and Labrador | |
Funding model | The province relied heavily on FFS and salary for FPs who deliver the bulk of primary care services [19]. FFS accounted for 75.4% of all clinical payments to FPs [19] |
EMR | Only 68% of physicians used an EMR [28]. An initiative to increase community-based physician access to the provincial EMR was introduced in 2016 [29] |
Integration with regional entities | Salaried physicians were employees of regional health authorities. There was limited integration of FFS FPs prior to the pandemic |
Interdisciplinary teams | Regional health authorities had not broadly integrated team-based models of care for salaried physicians [30]. In some rural/remote areas, community health centres offered more of an interdisciplinary presence, especially if virtual connections are considered [31] |
Number of FPs in a group | No reforms related to FP group size |