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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 Capitationb
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
  1. 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.
  2. 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.
  3. 3The base capitation rate is reduced to 50% for patients enrolled to a provider with a practice size exceeding 2,400
  4. 4 THAS = Telephone Health Advisory Service - A 24 hrs/7 days a week patient telephone advisory service available to enrolled patients.
  5. 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. 6 An incentive bonus that is reduced in relation to the number of visits patients make to non-specialists outside the FHN.
  7. 7 A penalty incurred from the capitation fee for visits patients make to non-specialists outside the FHN.
  8. 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.
  9. Informed by the Ontario Medical Association's "Comparison of Models" table - https://www.oma.org/PC/PCRComparisonJan0807.pdf (PCRComparisonJan0807.pdf)