Alma Ata declaration
first time public acknowledgement focus on human rights, equity
Why primary care important
- better population health
- reduce inequities
- lower costs
4 Cs of primary care
- continuity
- comprehensiveness
- coordination
- first contact
models of primary care - solo practise
- single physician supported by admin staff
- private, small business
- tend to be paid under fee for service
- doesn’t tend to exist much anymore
models of primary care: group
- multiple physicians working in shared space
mostly fee for service, but some captivated and blended payment models
models of primary care - interdisciplinary
- shared responsibility for patient care
- various funding and oversight models
models of primary care - walk in
- provide urgent care
- staffed by mix
- not intended as source of longitudinal care
- extended hours
paradox with more doctors than ever before
- more primary care drs than ever, but less primary care? physician shortage continue??
What drives shortage of physician
- total levels of service provision declines
- early retirements and reduce clinical activity
- changes in models of primary care practice
- gaps in data infrastructure and workforce planning
physician perspectives on reform
- alternative payment and non entrepreneurial models
two additional factors on shortage
- patient need and complexity
- administrative burden
Hutchison policy legacies for primary care
- Canadian federalism
- principle of public payment for private medical practise
- limitation to hospital and physician
lesson for policy making from Hutchison
- pursuit of Big Bang change under unfavourable may be futile…
make reform optional - progressive, incremental change
- linked to thoughtful and rigorous evaluation
operational primary care reform in BC
- incentive payments within fee for service payment system
- new physician led structures for policy making
current reforms in bc
- primary care networks
- urgent and primary care centres
-longitudinal family physician payment model
primary care networks
- network of physician owned/operated clinics within single geographic region
urgent and primary care centres
- same day access for urgent, non emergent health issues
longitudinal family physician payment model
- goal - to draw physician working in other models of care back to community based family medicine
compensate for
- physician time
- physician patient interactions
- physician’s patient panel
benefits and risks of longitudinal family physician
- move from FFS
- improved total compensation .. but with greater admin burden
- short term reduction in overall capacity
- continued reliance on physician owned and operated clinics
- uncertainty if will attract back to family medicine
- ignores best practise evidence
What should we aim for
- team based payment models
- publicly funded and managed infrastructure
what key element of Alma Ata
- necessity of health education and promotion in communities
statements on Alma ata
- primary care needs to be linked to prevention and promotion of population health
- primary health care should be universally accessible
- community participation in health care decisions is critical
Are walk in clinics coordinated
yes
Are urgent primary care centres continuous
yes
