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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.