title: Accountability and primary healthcare.
abstract: This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met.
authors.affiliation: Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Shaheena
authors.initials: S
authors.lastname: Mukhi
authors.affiliation: Associate Professor, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Jan
authors.initials: J
authors.lastname: Barnsley
authors.affiliation: Professor, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Raisa B
authors.initials: RB
authors.lastname: Deber
mesh_terms: D005380:Financing, Government; D018166:Health Care Reform / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D058007:Physicians, Primary Care / Q000191:economics* / Q000592:standards; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards*; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive / Q000331:legislation & jurisprudence; D012456:Salaries and Fringe Benefits; D012941:Social Responsibility