Canada - World Health Organization Regional Office for Europe

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,