Department of Family Medicine, McMaster University, Toronto, Ontario.
Health Aff (Millwood). 2013 Apr;32(4):695-703. doi: 10.1377/hlthaff.2012.1087.
Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation.
加拿大安大略省的初级保健经历了一系列改革，旨在改善医疗服务的可及性、患者和提供者的满意度、医疗质量以及卫生系统的效率和可持续性。我们强调了改革的主要特点，包括患者与初级保健提供者的签约、为跨专业初级保健组织提供资金以及根据按服务项目收费、人头费和按绩效付费的不同组合向医生支付薪酬。由于安大略省近 75%的人口现在已签约这些新模式，因此，2006 年至 2010 年间，向初级保健医生的总支付增加了 32%，并且报告对医学实践总体满意度的安大略省初级保健医生比例从 2009 年的 76%上升到 2012 年的 84%。然而，安大略省的初级保健也面临挑战。例如，目前还没有一个有意义的绩效衡量系统来跟踪这些创新的影响。人头付费计划还需要更好的风险调整系统，以便促使各团体有动力接收高需求患者。尽管存在财政限制，但仍需要对这些模式进行持续投资。我们建议制定明确的政策路线图，以继续进行改革。
