Canada - World Health Organization Regional Office for Europe

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104 Health systems in transition Canada 1. On getting ill, Mary visits her family physician where she is given a preliminary examination. Depending on the diagnosis, Mary could be given a prescription for a drug therapy, a referral for further diagnostic tests or a referral to a specialist. Mary does not pay for her physician visits or the cost of any physician-ordered, medically necessary diagnostic tests. 2. If given a prescription, Mary will go to a drug store of her choice and give the pharmacist the prescription signed by her physician. If she does not have private insurance or does not meet the requirements of her provincial drug plan, Mary may have to pay the full cost of the drug. 3. If sent for further diagnostic tests, Mary will provide blood or other bodily fluids at a private laboratory or get basic (e.g. radiography) or advanced (e.g. MRI) diagnostic tests either at a private clinic or a hospital. Since these tests are medically necessary, Mary will not be charged a fee irrespective of where she obtains the test. 4. Mary’s diagnostics results will be returned to the family physician. Once the physician receives the results, she or he will call Mary back to his or her office for a further consultation and, if necessary, explain the next steps in treatment. 5. If referred to a specialist (consulting) physician, Mary will be examined and a decision made concerning specialized treatment. Her family physician will be informed of the results. 6. If the treatment involves a surgical procedure or other acute intervention, Mary will be given a date to attend the hospital or, in cases involving more routine day surgeries, a specialized surgery clinic. 7. On Mary’s discharge from the hospital, her family physician receives a discharge summary from her specialist to allow for appropriate follow-up. 8. If Mary requires further home care or rehabilitation services, Mary’s doctor will provide a referral. If these services are deemed medically necessary by her physician, she will not pay; otherwise, she may pay part or all of the costs, depending on the coverage offered in her province of residence. 5.3 Primary / ambulatory care Primary care is defined as the individual’s first point of contact with the health system and, at its core, involves general medical care for common conditions and injuries. It can, and should, involve some health promotion and disease
Health systems in transition Canada 105 prevention activities although, unlike the public health services described above, these will be provided at the individual rather than population level. Ambulatory care refers to non-acute medical services provided to an individual who is not confined to an institutional bed as an inpatient during the time the services are provided. However, in Canada, since most specialized ambulatory care tends to be provided in a hospital on a day surgery basis, this type of care is dealt with as part of inpatient care in the following section. The traditional model of primary care in Canada has been one based on individual family physicians providing primary medical services on a fee-forservice basis. While rostering or other forms of patient enrolment or registration are not generally used, most family physicians have a relatively stable group of patients after the initial period required to build up a medical practice. And while patients are free to change their family physicians, most choose to have long-standing relationships with one physician. In the 1970s and 1980s, provinces and territories established a number of initiatives to improve primary care, including the establishment of communitybased primary care clinics in Ontario and Quebec. By the 1990s, there were a number of primary health care reforms initiated on a pilot basis. Despite this activity and earlier reforms, there was limited change by the end of the century (Hutchison, Abelson & Lavis, 2001). In the past ten years, there has been a renewed effort by provincial and territorial ministries to achieve some concrete improvements in primary health care. In the 10-Year Plan of 2004 (see section 6.1), all provincial and territorial governments committed themselves to ensuring that at least 50% of their respective residents would have access to primary care 24 hours a day, 7 days a week, commonly referred to as 24/7 access. Some jurisdictions have set targets concerning the replacement of fee-for-service remuneration by alternative payment contracts that encourage more time spent on consultation and diagnosis. Other jurisdictions are experimenting with different models of primary care delivery although most of the reforms are more evolutionary than revolutionary (Hutchison et al., 2011). The government of Ontario now has a number of different primary care practice models that are being assessed in terms of performance (ICES, 2012). These include the community health centres, a salaried model that services lower socioeconomic status populations; the family health groups based on a blended fee-for-service model; the family health networks and Family Health Organizations whose physicians are funded on a blended capitation model; and the family health teams which are made up of several types of professionals,
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Health Systems in Transition Gregor
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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List of abbreviations Abbreviations
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List of tables and figures Tables p
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Abstract Canada is a high-income co
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The European Observatory on Health
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Canada - World Health Organization Regional Office for Europe

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