TORONTO, - 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 added.
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.
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C.D. Howe Institute——Bio and Archives
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. Widely considered to be Canada's most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review.
