Abstract

BackgroundReliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams.MethodsWe use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied.ResultsOur conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved.ConclusionsThe development and application of a conceptual framework is an important step to the systematic study of the best performing financial models in the context of interdisciplinary primary care. The identification of optimal financial arrangements must be contextualized in terms of feasibility and the implementation environment. In general, financial hierarchy, both overt and covert, is considered a barrier to collaboration.

Highlights

  • Reliance on interdisciplinary teams in the delivery of primary care is on the rise

  • The financial structure of Interdisciplinary Primary Care (IDPC) teams has been recognized as an important contributor to team functioning and a key concern to policy makers in this area

  • The system is governed by a national Canada Health Act, which stipulates the broad conditions that Provinces/ Territories must comply with in order to qualify for federal budget transfers

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Summary

Introduction

Reliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. Mature health systems are placing increased emphasis on Interdisciplinary Primary Care Teams (IDPC Teams) to deliver primary care [1]. This approach has been described as more appropriate in addressing the health needs of populations by creating more comprehensive care options and increasing continuity and coordination [2,3,4,5,6]. Especially at the primary care level, delivery of services is by private providers This results in a set of 13 similar, yet unique health systems in Canada, making it an interesting case study from the international perspective

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