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Table 1 Features of models

From: Practice size, financial sharing and quality of care

 

Community Health Centre (CHC)

Fee for Service (FFS)

Family Health Group (FHG) a

Family Health Network (FHN)

Health Service Organisation (HSO)

Year Introduced

1970s

-

2004

2001

1970s

Group Size

Group practice, size unspecified

1 Physician

Minimum 3

Minimum 3

Minimum 3

Physician remuneration

Salary

FFS

FFS and incentives

Capitation b with a 10% FFS compon-ent and incentives

Capitation b and incentives

Patient enrollment

Required, no roster size limit

Not required

Required, No roster size limit

Required, Disincentive to enroll >2,400 c

Required, Disincentive to enroll >2,400 c

Access

No specified requirements

No specified requirements

THAS Extended hours e

THAS Extended hours d Access bonus e

THAS Extended hours d Access negation f

Multidisciplinarity g

Extensive

None

None

Some

Some

Assistance for information technology

Some

None

None

Yes

None

Objectives/ priorities

Responsiveness to Population needs, multidisciplinarity, prevention, focuson underserved, community-governed

-

Accessibility

Accessibility, comprehensivenes, doctor-nurse collaboration, use of technology

Responsiveness to population needs, multidisciplinarity, health promotion, cost effective-ness

  1. aLate in 2004, the Ontario Ministry of Health (MOH) created a new model of care, the FHG, to which FFS practices could transition. A family health group (FHG) is a collaborative comprehensive primary care delivery model involving 3 or more physicians practicing together. These physicians need not be located in the same physical office space, but must be within reasonable distance of each other. FFS practices converted to this new model quickly, so that by early 2006 most FFS practices had become FHGs, and it became evident that the great majority would transition by the year end.
  2. bUnder capitation remuneration, family physicians received a fixed monthly fee per patient enrolled, independent of the number of visits made to the practice by that patient. The capitation fee is based on the enrolled patient sex and age. FHN physicians receive an additional 10% of the FFS structure for each visit. The latter is intended to allow better monitoring of services delivered. In 2008 all HSO were converted to family health organizations. Under that model, the practices today also receive 10% of the FFS structure for each visit.
  3. c The base capitation rate is reduced to 50% for patients enrolled to a clinician with a practice size exceeding 2,400.
  4. dEach physician is required to provide at least 1, 3-hour session outside regular hours (evening/weekend) per week (up to 5 sessions per group/network/organization).
  5. eAn incentive bonus reduced in relation to number of visits patients make to nonspecialists outside the FHN.
  6. fA penalty incurred from the capitation fee for visits patients make to nonspecialists outside the FHN. Today, HSO practices are eligible for the access bonus are not subject to negation.
  7. gMultidisciplinarity refers to the presence of allied health professionals (eg, physiotherapist, social worker, and pharmacist), excluding nursing staff, but including nurse-practitioners.