Abstract
BackgroundPrimary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada’s most populous province.MethodsQualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario’s models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario.ResultsThere are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario’s models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario.ConclusionsPrimary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of “reform” and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.
Highlights
Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation
We provide a brief introduction to Canada’s health care system, the political and institutional context for primary care reform (PCR) in Ontario
We identify fundamental “core dimensions” of PCR that are most frequently identified in the PCR literature
Summary
Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. PHC that includes, but goes beyond a “narrow offer of specialized curative care” to embrace health promotion and the determinants of health, continues to promise “better health, less disease, greater equity, and vast improvements in the performance of health systems” [2]. Even when it does not fully attain this expansive vision, high-performing primary care (PC) is widely recognized as the foundation of an effective and efficient health care system. Much of PC continues to be provided to individual patients, by individual doctors, working in private practice on a fee-forservice (FFS) basis [6], often without after-hours arrangements or formal connections to other health care providers [7]
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