Table 1:
Characteristics of the four primary care models in the province of Ontario in 2005/06
| Fee for service | Capitation | ||||
|---|---|---|---|---|---|
| Characteristic | Salaried (community health centres)* | Traditional* | Reformed† | New (family health networks) | Established (health services organizations) |
| Year introduced | 1970s | – | 2004 | 2001 | 1970s |
| Group size, no. of physicians | > 1 (no specific size requirement) | 1 | ≥ 3 | ≥ 3 | ≥ 3 |
| Physician remuneration | Salary | Fee for service | Fee for service and incentives | Capitation with 10% fee- for-service component, and incentives | Capitation and incentives |
| Patient enrolment | Required; no limit on size of roster | Not required | Required; no limit on size of roster | Required; disincentive to enrol > 2400 | Required; disincentive to enrol > 2400 |
| Incentive for enhanced preventive care‡ | |||||
| Influenza immunization (age ≥ 65 yr) | None | None | None | April 2002 | July 2003 |
| Colorectal cancer screening (age 50–74 yr) | None | None | April 2006 | April 2006 | April 2006 |
| Breast cancer screening (age 50–70 yr) | None | None | None | April 2002 | April 2003 |
| Cervical cancer screening (age 35–70 yr) | None | None | None | April 2002 | April 2003 |
Community health centres and fee-for-service practices did not receive productivity or quality incentives. No model offered incentives for screening of visual or auditory impairment.
Late in 2004, the Ontario Ministry of Health and Long-term Care created a reformed fee-for-service model — the family health group — to which fee-for-service practices could transition. We combined these two fee-for-service models for our analyses.
Incentives for service enhancement of preventive manoeuvres, available through the Ministry of Health and Long-Term Care for the study period. Dates when the incentive bonuses came into effect are indicated in the cells. Incentives cover care delivered during the 30 months before the date the incentives became effective.
Source: Adapted from the Ontario Medical Association document comparing models (www.oma.org/Member/Resources/Documents/2008PCRComparisonChart.pdf), and supplemented with other information found on the Ontario Medical Association website.