PANEL 1: LEARNING FROM OTHER JURISDICTIONS
In the first panel discussion, Simone Thibault (Executive Director, Centretown CHC in Ottawa), Lisa Clatney (Executive Director, Saskatoon Community Clinic), and Gil Muñoz (Chief Executive Officer, Virginia Garcia Memorial Health Center, Hillsboro, Oregon) reflected on the important role CHCs have played in their respective jurisdictions. The panel was moderated by Marcy Cohen (Canadian Centre for Policy Alternatives – BC Office).
1. ‘Primary health care’ refers to a system-wide approach to designing health services based on primary care as the first point of contact in a system with a focus on addressing the social determinants of health and reducing avoidable disparities in health outcomes between different groups in society. A large body of evidence demonstrates that primary care is the foundation of an effective, efficient and high-performing health care system.
‘Primary care’ refers to the clinical level of primary health care, which should serve as the first point of contact with the health care system and where the majority of health problems are identified, treated and where other health and social care services can be mobilized and coordinated to prevent illness and support wellness.
2. Office of the Auditor General of Ontario (2017), Community Health Centres (3.03), p.189. All other primary care models are funded directly by the Ontario Ministry of Health/Ontario Health Insurance Plan. It is also worth noting that each CHC has an accountability agreement with their LHIN. Other primary care models do not have accountability agreements because non-CHC physicians are remunerated by the Ontario Ministry of Health/Ontario Health Insurance Plan (OHIP).
3. The only budget line that the clinic cannot change is the number of practitioners (i.e. physicians and/or physicians and nurse practitioners). But in most CHCs, these practitioners represented a minority of their total budget allocation.
4. See also: Daniel Muzyka (2012), The Inconvenient Truth about Canadian Health Care, Conference Board of Canada; Marcy Cohen (2014), How Can We Create a Cost-Effective System of Primary and Community Care Built Around Interdisciplinary Teams? Submission to the Select Standing Committee on Health, Vancouver: Canadian Centre for Policy Alternatives—BC Office; and Andrew Longhurst (2018, Jan. 15), How (and how much) doctors are paid in BC: why it matters, Policy Note, Canadian Centre for Policy Alternatives—BC Office.
5. The 2012 study concluded that “CHCs stood out in their care of disadvantaged and sicker populations and had substantially lower ED visit rates than expected” (p. iv).
6. Slides prepared by Adrianna Tetley (Executive Director, Alliance for Healthier Communities) show that the portion of CHC patients with a serious mental illness is more than twice that of other primary care models in Ontario.
7. The 2017 Ontario Auditor General’s report references articles from 2015 suggesting that CHCs had higher rates of hospital readmissions and emergency visits, but unlike the Glazier et al. 2012 study, the Conference Board research does take into account patient complexity (see Office of the Auditor General of Ontario, 2017, p. 194).
8. A large of body evidence shows that people with lower incomes have worse health outcomes, higher rates of chronic conditions and lower life expectancies. Chronic conditions account for nearly 67 per cent of health care costs in Canada (Provincial Health Services Authority (2011), Towards Reducing Health Inequities: A Health System Approach to Chronic Disease Prevention. A Discussion Paper.
9. In other primary care models, often referred to as patient enrolment models (i.e. capitation) physicians are paid for the number of patients enrolled with their practices and for a predetermined basket of services. In the Ontario patient enrolment model there is no adjustment for the differences in the complexity of health needs among different patient populations, and as a consequence, there is nothing to guard against practices favouring a patient population with lower complexity.
10. Ontario’s ‘family health teams’ (one of the province’s primary care models) is the only other model that is required to develop and submit quality improvement plans to Health Quality Ontario (the provincial agency that supports health care quality improvement).
11. This work was coordinated through the Alliance for Healthier Communities (previously the Ontario Association of Community Health Centres).
12. See, for example, the BC Medical Association’s (now called Doctors of BC) opposition to alternatives to fee-for-service compensation including the population-based capitation model: BC Medical Association (1995), Capitation: A Wolf in Sheep’s Clothing? Vancouver: BCMA.