Grant: Operating Grant

Primary care reforms, in Canada and internationally, have introduced different models of remuneration for primary care providers. These models differ in how they address variability in both patient and provider characteristics. How best to pay for primary care has major policy implications, because health costs are not homogeneous; most health costs are incurred by a small proportion of the population. Primary care physicians may also vary in how they prefer to practice. The proposed research will examine the characteristics of different reform models in Ontario and Manitoba, with an emphasis on how payment varies. It will examine the distribution of health expenditures in the populations of each province, overall, by age-sex group, and by sub-category of expenditures. It will then examine the relationship of both patient and provider characteristics to the primary care model with which they are associated, the extent to which the fiscal incentives to select into different models appear to be realized, and the implications for costs and access. The results should help ensure a better match between payment models and costs of caring for particular sub-groups of patients, and reduce the likelihood of such unintended consequences as providing financial disincentives to care for vulnerable populations.