Table 1: Descriptions of primary care models.
Model and description | Group size | Payment details |
---|---|---|
Fee-for-service models | ||
Traditional • "Full-service" primary care billing |
Solo | Fees as per the Ontario Schedule of Benefits for Physician Services |
Other • Locums • General practitioners whose practices focus on such areas as sports medicine or psychotherapy • Emergency Department Alternative Framework Agreement (physicians are primarily paid per diems) |
Solo | Fees as per the Ontario Schedule of Benefits for Physician Services |
Noncapitated enrolment models | ||
Family Health Group | Group (min. 3) |
Fee-for-service Enrolment fees and premiums for enrolled patients Incentives and bonuses After-hours premium |
Comprehensive Care Management |
Solo | Fee-for-service Enrolment fees and premiums for enrolled patients Incentives and bonuses After-hours premiums |
Rural models • Rural and Northern Physician Group Agreement • Group Health Centre • Community Sponsored Agreements • Weeneebayko Area Health Authority |
Group | Varies by model |
Capitated enrolment models | ||
Family Health Organizations | Group (min. 3) |
Blended capitation for enrolled patients (capitation plus fee-for-service shadow-billing premium for fee codes inside the capitated basket, plus fee-for-service for codes outside it) Access bonus for capitated services (at risk if patients see physicians outside the rostering group) Fee-for-service for non-enrolled patients Capped fee-for-service for core services to non-enrolled patients Incentives and bonuses After-hours premium |
Family Health Networks | Group (min. 3) |
Similar to Family Health Organizations, but the size of the capitated basket is smaller |
Other | ||
All other physicians not in one of the previously listed models |