title: Primary care in Ontario, Canada: New proposals after 15 years of reform.
abstract: Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. Electronic address: greg.marchildon@utoronto.ca.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Marchildon
authors.affiliation: Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Canada. Electronic address: hutchb@mcmaster.ca.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutchison
mesh_terms: D026683:Advisory Committees; D002204:Capitation Fee; D018588:Fee-for-Service Plans / Q000191:economics*; D018166:Health Care Reform / Q000379:methods*; D006291:Health Policy; D006801:Humans; D009864:Ontario; D011320:Primary Health Care / Q000191:economics*
keywords: Canada; Capitation; Fee-for-service payment; Health care reform; Health system reform; Ontario; Policy development; Primary care; Primary care physicians; Rostering; Salary