ICES study compares different primary care models
The Institute for Clinical and Evaluative Services (ICES) released a new report that evaluates different primary care models by looking at the patient population served in each model, and the utilization rates of emergency departments (EDs) by that population group.
This study examined patients/clients enrolled in seven different groups that included:
- Community Health Centres (CHCs, a salaried model),
- Family Health Groups (FHGs, a blended fee-for-service model),
- Family Health Networks (FHNs, a blended capitation model),
- Family Health Organizations (FHOs, a blended capitation model),
- Family Health Teams (FHTs,an interprofessional team model composed of FHNs and FHOs),
- ‘Other’ smaller models combined, and
- Population groups who did not belong to any model.
The study found interesting differences in the sociodemographics served by the various primary care models, and in spite of what might be expected, significant variations in the use of emergency departments.
For example, compared with the Ontario population CHCs served more people living in lower income neighbourhoods, more newcomers and those on social assistance. They also served individuals with more severe mental illness and chronic health conditions, and higher morbidity and comorbidity rates. In spite of the demographic profiles, CHCs had ED visit rates that were significantly lower than anticipated in both urban and rural areas. There is no explanation for these better outcomes and this requires further investigation.
On the other hand, Ontario’s capitation models served more advantaged populations and had higher than expected ED rates. The details of physician reimbursement mechanisms in capitation appear to be important for achieving desired results; the payment and incentive structures underlying these models require re-examination.
In another key finding, ICES found that people who did not belong to one of the models of care studied were more likely to be male, younger, make less use of the health system and have lower morbidity and comorbidity than those enrolled in a model of care, yet they had more ED visits than expected.
The report contains many interesting observations and concludes that more evaluation is needed to understand the performance and costs, of Ontario’s primary care models.
For more information go to www.ices.on.ca.