TORONTO, Nov. 19, 2013 /CNW/ - Ontario healthcare reforms have made
headway in improving access to primary care by implementing the
"capitation" model where doctors are paid mainly for a roster of
patients rather than fee-for-service - but too many of patients are
still using "outside" doctors, according to a report from the C.D. Howe
Institute. In "Accountability and Access to Medical Care: Lessons from
the Use of Capitation Payments in Ontario," authors Åke Blomqvist,
Boris Kralj and Jasmin Kantarevic suggest an area for further reform
would be to encourage patients to stick to their regular doctor.
"While enrolling doctors face a financial penalty if their patients
choose to get healthcare elsewhere, patients have no incentive to avoid
outside visits," noted Åke (pronounced "Oke") Blomqvist, Health Policy
Scholar at the institute.
Over the last decade, Ontario has reformed primary care to pay family
doctors more on a capitated, or per patient, basis and less on a
fee-for-service basis, note the authors. This has been coupled with an
emphasis on patient enrollment with a specific family doctor, or group
of doctors, to improve both access and the relationships between family
doctors and patients.
However, even with greater access to family doctors in Ontario than in
the past, there were over 1.7 million visits by enrolled patients to
outside doctors in 2011/12. A cursory review of claims data suggests
that visits outside of one's family doctor are largely due to patient
choice based on convenience of care.
"Ontario's healthcare system could realize better value-for-money were
fewer patients to seek such outside care," said Blomqvist. "One area
for reform would involve better designed incentives for patients that
complement the existing incentives for providers. We recommend other
provinces follow Ontario's model but with this important caveat," he
The authors recommend, as first steps, that doctors should be encouraged
to explain more clearly to patients that by signing the rostering
agreement, they have agreed that they will only seek care from an
outside provider when they have a good reason for doing so. As well,
the Ministry of Health and Long-Term Care could expend more effort to
explain the rationale for the rostering model, and that it does imply
some obligations on patients as well as physicians.
"Even though we recognize that it would be highly controversial, we also
think it reasonable to ask patients, like in the United Kingdom, to pay
part of the cost of their care out-of-pocket if they chose to go to an
outside provider purely for reasons of convenience," he added. Leeway
could be given to patients who work long distances from home - all
patients with a greater than one-hour commute to work could be
permitted one or two outside visits per year before charges begin, for
instance. Further flexibility could be given for patient visits during
off-regular hours of care as well as for same-day needs, and so on.
The C. D. Howe Institute is an independent not-for-profit research
institute whose mission is to raise living standards by fostering
economically sound public policies. It is Canada's trusted source of
essential policy intelligence, distinguished by research that is
nonpartisan, evidence-based and subject to definitive expert review. It
is considered by many to be Canada's most influential think tank.
For the report go to: http://www.cdhowe.org/accountability-and-access-to-medical-care-lessons-from-the-use-of-capitation-payments-in-ontario/23498
SOURCE: C.D. Howe Institute
For further information:
For more information contact: Åke Blomqvist, Adjunct Research Professor, Carleton University and Health Policy Scholar, C.D. Howe Institute; or Colin Busby, Senior Policy Analyst, C.D. Howe Institute, 416-865-1904.