An evaluation of gender equity in different models of primary care practices in Ontario

Dahrouge, Simone; Hogg, William; Tuna, Meltem; Russell, Grant; Devlin, Rose Anne; Tugwell, Peter; Kristjansson, Elisabeth

doi:10.1186/1471-2458-10-151

BMC Public Health

Table 1 Ontario's main primary care models in 2005/2006.

From: An evaluation of gender equity in different models of primary care practices in Ontario

	Community Health Centre (CHC)	Fee for service (FFS)		Family Health Network (FHN)	Health Service Organization (HSO)
		Traditional Fee for Service	Family Health Groups (FHG)¹
Year introduced	1970s	-	2004	2001	1970s
Group size	Groups practice - Unspecified size	1 Physician	Minimum 3	Minimum 3	Minimum 3
Physician remuneration	Salary	FFS	FFS and incentives	Capitation² with a 10% FFS component, and incentives	Capitation^b and incentives
Patient enrolment	Required No roster size limit	Not required	Required No roster size limit	Required Disincentive to enrol >2,400³	Required Disincentive to enrol >2,400³
Access	No specified requirements	No specified requirements	THAS⁴ Extended hours⁵	THAS Extended hours⁵ Access bonus⁶	THAS Extended hours⁵ Access negation⁷
Multi-disciplinarity ⁸	Significant	None	None	Some	Some
Assistance for Information Technology	Some	None	None	Yes	None
Objectives/Priorities	Responsiveness to population needs, multi-disciplinarity, prevention, focus on underserved, equity community governed	-	Accessibility	Accessibility, comprehensiveness, doctor-nurse collaboration, use of technology	Responsiveness to population needs, multi-disciplinarity, health promotion, cost effectiveness

¹Late in 2004, the Ontario Ministry of Health (MOH) created a new model of care, the FHG, to which FFS practices could transition. Family Health Groups (FHG) needed to comprise three or more family physicians practicing together. These physicians need not be located in the same physical office space, but must be within reasonable distance of each other. FFS practices converted to this new model quickly, so that by early 2006 most FFS practices had become FHGs, and it became evident that the great majority would transition by the year end.
²Under capitation remuneration, family physicians received a fixed monthly fee per patient enrolled, independent of the number of visits made to the practice by that patient. The capitation fee is based on the enrolled patient sex and age. FHN physicians receive an additional 10% of the FFS structure for each visit. The later is principally intended to allow for a better monitoring of the services delivered.
³The base capitation rate is reduced to 50% for patients enrolled to a provider with a practice size exceeding 2,400
⁴ THAS = Telephone Health Advisory Service - A 24 hrs/7 days a week patient telephone advisory service available to enrolled patients.
⁵Each physician is required to provide at least one 3 hour session outside regular hours (evening/week end) per week (up to 5 sessions per group/network/organization)
⁶ An incentive bonus that is reduced in relation to the number of visits patients make to non-specialists outside the FHN.
⁷ A penalty incurred from the capitation fee for visits patients make to non-specialists outside the FHN.
⁸ Multi-disciplinarity refers to the presence of allied health workers (e.g. dietician, social worker, and pharmacist), excluding nursing staff, but including nurse practitioners.
Informed by the Ontario Medical Association's "Comparison of Models" table - https://www.oma.org/PC/PCRComparisonJan0807.pdf (PCRComparisonJan0807.pdf)

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ISSN: 1471-2458

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