Marchildon Gregory P, Hutchison Brian
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Canada.
Health Policy. 2016 Jul;120(7):732-8. doi: 10.1016/j.healthpol.2016.04.010. Epub 2016 Apr 23.
Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province.
在加拿大，由于20世纪60年代国家与医生之间达成的原始社会契约促成了全民医疗保险的引入，事实证明，初级医疗保健改革极其困难。然而，在过去十年中，安大略省政府在加拿大率先为一系列初级医疗实践模式提供资金，其中一些模式与基于按服务收费的传统单人及团体医生执业模式有很大不同。独立评估显示，患者护理方面有一些积极改善。尽管如此，安大略省政府在改革方面的大量投资，加上对改善绩效的高期望以及该省财政状况的不断恶化，导致在医生预算问题上与有组织的医学界发生重大冲突，并且政府还考虑对该省的初级医疗保健系统进行更激进的重组。
