Longwoods Blog

Our first point of contact with the health system — often referred to as “primary care” — should result in prompt and efficient care for our general health concerns, and coordinate our journey through the system when we need more specialized care.

That’s if things are working properly. Unfortunately, this isn’t always the case.

In the early 2000s, there was widespread concern across Canada that primary care was in decline. Walk-in clinics and emergency departments became the de facto point of care for patients who lacked timely access to a family doctor. Patients struggled to find doctors to take them on as regular patients.

Though British Columbia was not alone among Canadian provinces in recognizing the need for primary care reform, it was unique in its approach to solving the problem. B.C.’s chosen fix for primary care was based on the simple and appealing idea that we have to pay for what we want.

B.C. attempted to coax individual doctors to provide important primary care services (chronic disease management, mental health care and preventative care, for example) and discourage walk-in style practice by providing additional incentive payments within the public fee-for-service system.

In contrast, other provinces changed the structure and organization of primary care, moving toward team-based models of care and away from fee-for-service compensation for doctors. Other countries also implemented incentive payments for doctors, but unlike B.C., these models were tied to reporting on performance.

The costliest incentive implemented under the B.C. program was a $315 annual payment made to doctors — on top of regular patient visit fees — for providing ongoing care for complex patients (someone with two or more qualifying chronic diseases). B.C. now spends more than $50 million each year on this single incentive and another $100 million on similar ‘extra’ payments for obstetrics, mental health care, preventive risk assessment and management of individual chronic diseases.

In a recently-published study in the Canadian Medical Association Journal, we investigated the effects of these complex care payments. We observed that two out of three eligible patients have these incentives billed for their care. However, we saw no change in the number of primary care visits patients received or in the continuity of their relationships with a regular doctor. Hospitalization rates did not go down.

From what we can see looking back, care remained the same, while costs went up.

More broadly, B.C. patients today still struggle to access quality primary care where and when they need it. Even patients with a doctor often resort to emergency departments and walk-in clinics because less than a third of B.C. doctors report having any other arrangements for after-hours care.

Read the entire blog post here


Kimberlyn McGrail, Associate Professor, Centre for Health Services and Policy Research, University of British Columbia

Ruth Lavergne, Assistant Professor in the Faculty of Health Sciences at Simon Fraser University and expert, EvidenceNetwork.ca.

This entry was posted on Friday, September 9th, 2016 at 1:54 pm and is filed under Publisher's Page.