Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation
Author(s)/Editor(s): Glazier RH, Klein-Geltink J, Kopp A and Sibley LM
Publication date: May 26, 2009; 180 (11)
"Primary health care is facing a number of serious challenges internationally, with questions being raised about whether it will even survive in some settings. 1 Fundamental issues include shortages in human resources and maldistribution of physicians; dissatisfaction on the part of providers and patients; gaps between guideline-recommended care and provided care; and a preference of trainees to choose specialty careers. Close to 4 million Canadians do not have a family physician, and more than 2 million report difficulties in accessing routine or ongoing care at any time of day as well as immediate care for minor health problems at any time of day. 2 Canadians in rural areas face geographic barriers to care, fewer available health care professionals than in urban areas and higher rates of disease."
"In response to these challenges, policy-makers in Canada and elsewhere are considering or are implementing interdisciplinary teams, new organizational structures, new governance and reimbursement models, requirements for after-hours care, provision of after-hours advice by telephone, electronic health records and other information technology, and pay-for-performance initiatives. Many of these directions are incorporated in the Medical Home concept in the United States 4 and in the Quality and Outcomes Framework in the United Kingdom. 5 Although there is evidence for the effectiveness of some of these initiatives, most have not been rigorously evaluated. Reimbursement models, perhaps the best-studied aspect of primary care reform, seem to influence some aspects of physician behaviour. However, there is a lack of evidence about their ultimate impact on patient outcomes.”