Primary Care Flashcards
Differentiate between Primary Care and Primary Health Care.
Primary care:
the shorter term defines a narrower model of Family doctor type
Primary Health care:
- Holistic approach to health policy and services (social determinants of health)
- Contains prevention and health promotion
What are the core principles of Primary Health Care (4)
- Universal
- Equity
- Community Participation
- Intersectoral
What are the characteristics of Primary Health Care (6)
- First level of contact
- Close to where people live and work
- First step in a continuing care process
- Include the main health problems
- ***Include promotive, preventative, curative rehab services
- Accessible 24/7
What is physician supply associated with?
Means: # of physicians per 10,000
associated with better health outcomes, better lifestyle, lower costs
What is the percentage of Canadians that can get same or next day appointment. What about the opposite?
51% of Canadians can get same or next day app.
62% of Canadians reported not getting same or next day app.
When Canada was planning on reforming primary care to primary health care, what were the 3 issues?
IAM
- Introduction of patient enrolment
- Alternative payment plans
- Multidisciplinary teams
What will introduction of patient enrolment help in the reform?
- it will formalize a relationship between the physician and the patient
- it is voluntary for both parties
- Requires dual commitment
What does traditional fee-for-service payment model mean?
What are its theoretical issues?
- Physicians bill to OHIP
- Payment made for each service
- Physicians are independent and self-employed
- Payment from MOHLTC is used to cover all clinic expenses
Issues
- Over care
- barriers to interprofessional
What does a capitation payment model mean?
What are its theoretical issues?
- payment based on # of enrolled patients
- It is adjusted for age and sex
- Not adjusted for health status
- Does not look at # of visits
Issues
- Can select only healthy patients
What are some incentives offered to MDs as an alternate payment plans
- Rostering patient fees
- Chronic disease management
- Preventive care
What is the issue with salary APP
low productivity
What are the 5 family practice APP
- FFS with bonuses to enrolled patients
- Salaried model
- Blended capitation model
- Blended salary model
- Complement-based remuneration and incentives
What are the multidisciplinary teams (3) which also contain pharmacists
Community Health Centres CHC
Family Health Teams FHT
Nurse Practitioner Led Clinics NPLCs
What were the first primary health care organizations to be created that have transformed?
What were their payment model
Health service organization HSO
Primary care networks PCN
Capitation
What do Community Health Centres CHC focus on?
What are their payment models?
What is it funded by?
- Focus on social determinants of health and health promotion
- Physicians are employees and paid with a salary
- Funded by LHINs (Ontario health) (Global budget)
What are Family health Networks replaced FHN?
What are their payment model?
Replaced PCN
Blended Capitation: capitation reimbursement + limited FFS and incentives
- Patients are enrolled to physicians
What are Family Health Groups FHG?
What are their payment models?
- Groups of at least 3 FPs/GPs
Blended FFS: FFS payment + bonus & premium payments - Voluntary enrolment of patients
- Move from FFS solo to group practice
What is the payment model for Rural-Northern Physician Group?
Blended complement model: base remuneration (based on # of physicians)
5% shadow billing
1-7 physicians
What are Family Health Organizations FHO?
What are their payment models?
What is it funded by?
- 3+ physicians
- MAINLY capitation model (but still a little blended)
- Governance and Lead Physician
- Difference between FHN and FHO is scope of included codes and capitation rate
How does Comprehensive Care Model CCM work?
Payment model?
- Solo physician
- Blended FFS + CCP
How do Family Health Teams FHT work?
What are their payment models?
What is it funded by?
- Team practice
- Independent, non-profit
- Blended Salary
- Has funding for other: executive director, allied health professionals, implementation of electronic medical records
How do Nurse Practitioner-Led Clinics NPLC work?
What are their payment models?
What is it funded by?
- Independent, non-profit
- Team practice
- Salary
- Global budget
Which 3 Primary Health Care organizations do not have patient enrolment
- Community Health Centre CHC
- Nurse Practitioner-Led Clinics NPLC
- FFS
How much percent of MDs are in an FFS model in 2015
25%
