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The Ontario government is reorganizing health care, from the Health Ministry to the doctor’s office. To meet the goals of reducing wait times, constraining costs and ensuring patients have access to high-quality health care, the government should address fundamental challenges in primary care and how family doctors are paid.

Ending hallway medicine was one of the signature campaign promises of the Ontario Progressive Conservatives when they were elected. To this end, the government proposed a health care system reorganization, featuring a network of Ontario Health Teams with responsibility for supplying “integrated” health care to all residents.

Patients and health professionals are waiting to hear what the government will do with the many proposals to form health teams, what services they will provide, and how. Many of them are likely from groups of professionals who deal with specific health problems, or from informal networks in local communities.

The government should keep in mind, however, that the ultimate objective is to transform the entire system to provide higher-quality co-ordinated care. To do so, it must bring all sectors into the process, starting with the family doctors, nurse practitioners and family health teams who supply the primary care that is its foundation.

A key element in several high-performing health-care systems abroad has been a well-established relationship between each patient and a primary-care provider who serves as the patient’s health care adviser and manages the care and drugs they receive from all providers.

This has been the model in the U.K., the Netherlands, and in several of the more successful parts of the U.S. managed-care sector. To create a province-wide network of OHTs that gives a “medical home” to every resident, the Ontario government should learn from these models.

It should also build on the experiments with enrollment-based methods of compensating primary-care providers that have been ongoing in Ontario since the late 1990s. The experiments have used the principle of capitation, a compensation method that pays doctors in part based on the number of patients who have signed up with their practice.

Capitation is like a lawyer’s “retainer” — it is paid every month whether or not a patient actually received any services. In return the doctor agrees to see the patient when they need care, to ensure arrangements for after-hours care, and to bill the province for “core services” at discounted rates.

The Ontario capitation experiments started partially because many patients had trouble finding a family doctor who was willing to take on new patients. In that respect, they’ve had some success: In 2016, 92.3 per cent of Ontarians reported having a regular care provider, more than any other province.

Some also hoped capitation would help contain health-care costs, but there is no evidence that it has had this effect. Payments to primary-care providers have continued to grow. While economic theory suggests that capitation gives doctors an incentive to focus more on preventive care, there isn’t convincing evidence that has happened to a significant extent in Ontario. The experiment also hasn’t had the intended effect of helping alleviate pressure on crowded hospital emergency rooms after hours and on weekends.

Overall, the evidence on the effectiveness of physician payment reforms in Ontario may not seem encouraging, and the government’s desire to go in new directions is understandable.

In our recent report, however, we argue that rather than abandon the new models for compensation of primary care at this stage, the government should take them further. The idea that in a well-functioning health-care system, patients have to have an accountable provider as their medical home is more convincing than ever.

A patient enrolment model based on capitation is by far the most logical basis for such a system. Moreover, the Ontario capitation schemes were watered-down versions of the methods that have been used elsewhere (in the U.K., for example).

The Ontario government should continue moving in the direction of stricter versions of capitation as the basis for compensating primary-care providers, and use capitated primary-care providers as the backbone of the new OHTs.

Åke Blomqvist is health policy scholar at the C.D. Howe Institute and an adjunct research professor at Carleton University. Rosalie Wyonch is a policy analyst at the C.D. Howe Institute.

Published in the Toronto Star