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. 2021 Nov 8;21(4):12. doi: 10.5334/ijic.5680

Table 1.

Policy actors, context, and process by case.

PROVINCE PRIMARY ACTORS CONTEXT PROCESS
BC

  • BC Ministry of Health

  • Doctors of BC

  • General Practice Service Committee

  • Five Regional Health Authorities (RHAs)

  • Ministry of Health oversees management of health services

  • Primary care teams began in 2008 as Integrated Health Networks, through RHAs and BC Medical Association

  • Primary Care Networks (PCNs) implemented (2018)

  • Policy documents development processes not standardized

  • Goal to transform family physician practices and primary care clinics into team-based Patient Medical Homes, linked and connected with a team-based PCN and RHA

  • A Medical Health Officer designated for each PCN for regional/provincial connection
AB

  • Government of Alberta (Alberta Health [AH])

  • Alberta Health Services (AHS)

  • Alberta Medical Association (AMA)

  • Trilateral Master Agreement signed by AMA, AH and Regional Health Authorities (2003)

  • PCN model adopted (2005) with 80% physicians attached to PCNs (2016); most experience with PCN model

  • Single province-wide health authority implemented (AHS) (2009)

  • Policy documents developed by AH; implemented by PCNs as a condition of grant agreements

  • PCNs are joint ventures between family physicians and AHS, accountable to AH

  • PCNs funded by AH

  • Physicians’ practices largely use fee-for-service model
ON

  • Ministry of Health (MOH)

  • Health Quality Ontario (HQO)

  • Ontario Primary Care Council (OPCC)

  • Local Health Integrated Networks (LHINs)

  • Association of Family Health Teams of Ontario (AFHTO)

  • Interprofessional teams in Community Health Centres for 40 years

  • Various primary care models introduced (2000–2010)

  • Interprofessional Family Health Teams (FHTs) introduced (2006)

  • Innovations in remuneration models such as Enhanced Fee-For-Service models, capitation models, salary models, and various incentives and bonuses

  • Change in government with reform to dismantle LHINs and introduce Ontario Health Teams (OHTs) (2019)

  • MOH implements and evaluates policy guidelines for the province

  • LHINs identified as catalyst for improving integration at the local level through Integrated Health Service Plans for regional governance based on provincial guidelines

  • MOH established HQO to evaluate Ontario health system, including primary care; external evaluations commissioned of primary care models, particularly FHTs

  • Policy is shifting from identifying primary care as a key enabler of integration
QC

  • Ministry of Health and Social Services (MHSS) of Quebec

  • Health and Social Services Centres (HSSC)

  • Integrated Health and Social Service Centres (IHSSC)

  • College of Physicians of Quebec

  • Quebec Nurses Association

  • Introduction of interprofessional (physicians and nurses) Family Medicine Groups (2001)

  • Creation of 95 HSSC through administrative mergers of hospitals, community service centres and long-term care facilities (2004)

  • Creation of 22 IHSSCs through administrative mergers of HSSCs, rehabilitation centres and youth centres (2015)

  • Social workers introduced into Family Medicine Groups (2016)

  • High level policy documents developed by government and implemented by MHSS

  • Regional health and social service agencies, HSSCs and IHSSCs adapt policies to local context/priorities.

  • Regional health and social service agencies, HSSCs/IHSSCs accountable to MHSS through regular reports and data submission

  • Leveraging administrative mergers (HSSCs/IHSSCs) of public healthcare organisations to enhance inter-organizational connectivity through health networks.