The Price Report has been circulated around for some time I understand. It seems to be elusive on the "internet of things" so that means it is in a crevice at the Ministry of Health and Long-term Care...the same place that refuses to provide the current utilization costs of Ontario's physicians to physicians.
This ghostly report apparently contains a plan to allow Patient Care Groups to set the demand for MDs. No space for an MD in a certain region/hub, no job. This isn't much different from what exists now in terms of publicly funded health care infrastructure being the limiting factor but it does create a whole new realm of freedom killing logistics for new MDs and a whole other layer of obstruction to care.
It's a sad state of affairs when a government that expounds on the virtues of transparency and accountability won't provide the details of its plans and I use that term loosely.
What Patient Care Groups will do is attempt to herd MDs into areas where the Ministry would like them to go. This has been tried in a number of ways before. None of the government efforts have been effective mostly because MDs are very intelligent and resourceful and resilient and find other ways to accomplish their goals and meet patient need.
The herding may have the opposite effect and result in MDs finding other livelihoods associated with medicine or simply moving to jurisdictions where their expertise is appreciated in a more holistic way.
The needs of northern communities and other more rural and remote areas have been met to some degree with MDs who rotate through often on a weekly or a monthly basis. With the PCG scheme will they continue to come? Would the mechanism by which MDs are herded lend itself to this approach? If not, some of these areas could find themselves worse off than before.
Now, I must admit I have not read the Baker-Price Report. I have seen parts of it. But to all of the new MDs looking for permanent or semi-permanent postings, be concerned.
The Ontario Medical Association has been quiet on this front. Perhaps it doesn't have the Baker-Price Report either. This doesn't seem to be a very good way to run a health care system--keeping MDs in the dark about their futures, their ability to earn a living and shooting any kind of transparent negotiation process all to bits.
Surely, when Dr Eric Hoskins trots out into the media to set "the record straight" about his government's achievements in creating new MDs he ought to include the plans for their future positions.
Given the cuts to medical residencies along with the bravado about how many more MDs Dr Hoskins and the Ministry want to take credit for, one has to wonder how how many MDs are going to waste and if not driven from the province, how the government will pay for their services.
Currently, the Ministry isn't sharing much. Not their plan. Not the utilization costs...not too much of anything except its big stick.
Good luck with that.
It hasn't worked before and it won't work now. Perhaps Dr Hoskins' next plan is to build a big wall around Ontario to keep Ontario MDs-it would be a logical next step given the demonstrated brashness and short-sightedness seen so far from Ontario's Ministry of Health.
For your interest, here is the executive summary:
Executive Summary In late 2013 the Ministry of Health and Long-Term Care (the “Ministry”) convened the Expert Advisory Committee on Strengthening Primary Health Care in Ontario to address current challenges in Ontario’s primary care system. The Ministry identified four policy questions of particular interest:
1. How can we ensure all Ontarians are attached to a regular primary care provider?
2. How can we ensure that Ontarians who need the services of an interprofessional care team can obtain them?
3. How can we improve integration in Primary Care, both among primary care providers and between primary care and other parts of the system?
4. How can we ensure Ontarians can access primary care after business hours and on weekends
when needed? In response, the Committee has proposed a vision for a cohesive primary health care system for Ontario, based on a redesign of the province’s existing primary care sector.
The redesign includes the following features:
1. A population-based model of primary care delivery, designed around Patient Care Groups
(PCGs); which are fund-holding organizations that are accountable to the Ministry through the
Local Health Integration Networks (LHINs).
2. Groupings of Ontarians are formed based on geography5, akin to the assignment of students
within the public school system. Citizens within each grouping are assigned to a PCG. The PCG ensures universal access to primary care for all of its citizens; there are no unattached patients.
3. Funding to each PCG is determined on a per capita basis, reflecting the demographics,
geographic rurality of the population, socio-economic status, and projected health needs of its catchment population6. The PCG then contracts with its local primary care providers, honouring existing relationships and agreements currently in place, to deliver primary care services to its
citizens. Primary care providers, along with the local Public Health unit and municipal services, are responsible for the health of the population within their catchment area.
4. The model recognizes that a citizen’s health is determined by many factors beyond the health system and supports partnerships between primary care and other sectors to build a culture of
community health and wellbeing.
5. The model ensures clear lines of accountability between primary care providers and patients,
and between care providers and the broader system. 5 Partially based on analysis of natural groupings of primary care entities by ICES
6 Funding levels will be determined in partnership with Public Health and others involved in epidemiological
analysis and research.
7. The model ensures better integrated care, both horizontally (coordination between primary health care practice settings) and vertically (coordination between primary health care and other parts of the system). This model has the potential to enhance the horizontal and vertical integration component of Health Links’ activities.
8. The model ensures that quality and fiscal responsibility are rewarded. Provider groups and individual providers, who may be subcontracted to provider groups, are contracted with based
on their ability to achieve quality benchmarks and any additional criteria/metrics captured in
their accountability agreement. Contract granting and renewal will be performance based, and support may be available to providers when performance does not meet standards.
9. The model offers the benefits of economies of scale through the PCG central functions but also allows and rewards adaptation to local needs.
10. The focus is on the functions of a PCG necessary for effective primary health care delivery, not
on who performs them. Current structures and organizations will be leveraged wherever
possible, and when new structures are required they will replace an existing entity, not add a new one.
Here's the link: