Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong> 105<br />
prevention activities although, unlike the public health services described<br />
above, these will be provided at the individual rather than population level.<br />
Ambulatory care refers to non-acute medical services provided to an individual<br />
who is not confined to an institutional bed as an inpatient during the time the<br />
services are provided. However, in <strong>Canada</strong>, since most specialized ambulatory<br />
care tends to be provided in a hospital on a day surgery basis, this type of care<br />
is dealt with as part of inpatient care in the following section.<br />
The traditional model of primary care in <strong>Canada</strong> has been one based on<br />
individual family physicians providing primary medical services on a fee-<strong>for</strong>service<br />
basis. While rostering or other <strong>for</strong>ms of patient enrolment or registration<br />
are not generally used, most family physicians have a relatively stable group<br />
of patients after the initial period required to build up a medical practice. And<br />
while patients are free to change their family physicians, most choose to have<br />
long-standing relationships with one physician.<br />
In the 1970s and 1980s, provinces and territories established a number of<br />
initiatives to improve primary care, including the establishment of communitybased<br />
primary care clinics in Ontario and Quebec. By the 1990s, there were a<br />
number of primary health care re<strong>for</strong>ms initiated on a pilot basis. Despite this<br />
activity and earlier re<strong>for</strong>ms, there was limited change by the end of the century<br />
(Hutchison, Abelson & Lavis, 2001). In the past ten years, there has been a<br />
renewed ef<strong>for</strong>t by provincial and territorial ministries to achieve some concrete<br />
improvements in primary health care.<br />
In the 10-Year Plan of 2004 (see section 6.1), all provincial and territorial<br />
governments committed themselves to ensuring that at least 50% of their<br />
respective residents would have access to primary care 24 hours a day,<br />
7 days a week, commonly referred to as 24/7 access. Some jurisdictions have<br />
set targets concerning the replacement of fee-<strong>for</strong>-service remuneration by<br />
alternative payment contracts that encourage more time spent on consultation<br />
and diagnosis. Other jurisdictions are experimenting with different models of<br />
primary care delivery although most of the re<strong>for</strong>ms are more evolutionary than<br />
revolutionary (Hutchison et al., 2011).<br />
The government of Ontario now has a number of different primary care<br />
practice models that are being assessed in terms of per<strong>for</strong>mance (ICES, 2012).<br />
These include the community health centres, a salaried model that services<br />
lower socioeconomic status populations; the family health groups based on a<br />
blended fee-<strong>for</strong>-service model; the family health networks and Family <strong>Health</strong><br />
<strong>Organization</strong>s whose physicians are funded on a blended capitation model; and<br />
the family health teams which are made up of several types of professionals,