Canada can learn lessons to inform policies on primary care from other Organization for Economic Co-operation and Development (OECD) countries, according to a study conducted by the Canadian Medical Association Journal (CMAJ). “We propose related actions that can be taken by governments, professional associations and clinicians; special consideration needs to be given to enhancing access in rural areas, which is not specifically discussed,” said the CMAJ authors in the study. The CMAJ authors said most family physicians in Canada are private contractors who carry no obligations or accountability for the breadth of services they provide, the location of their practices, their hours of operation, their staffing mix, the patients they accept or their ability to meet local population needs. In turn, they said they often receive little support from healthcare systems for infrastructure needs. Countries with high attachment have primary care clinicians often working in office-based, generalist practice. Clinicians and professional organizations could consider whether or not bringing physicians into the system might have benefits for physicians and people amid current challenges.The CMAJ went on to say federal, provincial, and territorial governments could increase the proportion of health spending that is public. With health budgets, they said a higher proportion should be spent on primary care, which would enable needed infrastructure and workforce development. Canada has a low number of physicians per capita. Fewer physicians means they need to step in to support other parts of the healthcare system, which leaves less of the workforce oriented toward office-based care. Local or provincial and territorial governments could move to a system where people are registered or have the right to with a group practice close to home. These group practices would provide primary care services paid for by the government and would need to be resourced to meet population need. Shifting tasks to other healthcare workers could increase workforce capacity, especially if they could be the first point of contact. While guaranteeing access to primary care might result in a trade-off with relational continuity and access for non-urgent care, they said such trade-offs “may be better than the status quo of high levels of nonattachment to primary care in Canada.”They said provincial and territorial governments and professional associations could work to increase uptake of salary or capitation payment for doctors to obtain more population coverage. Capitation provides a set payment per patient adjusted for age, sex and medical or social complexity and incentivizes larger patient panels.Other countries have far fewer walk-in clinics and have standards or accountability for swift access. Having fewer walk-in clinics allows more of the primary care workforce to deliver generalist, continuity-based, office-based care. The CMAJ authors concluded by saying primary care “is the front door of the health care system, yet almost one in five people living in Canada did not have a primary care clinician at the outset of the pandemic, and the situation is poised to get worse if left unaddressed.”“Canada can learn from OECD countries such as the Netherlands, Norway, the UK, and Finland, where more than 95% of people have a primary care clinician, near-universal insurance coverage exists, the proportion of health spending that is public and spent on primary care is larger than Canada’s and GPs (general practitioners) are organized better in teams and are more accountable for the care they must provide,” they said. “These international examples can inform bold policy reform in Canada to advance a vision of primary care for all.”Canadian patients are waiting longer than ever for medical treatment, according to a 2022 study conducted by the Fraser Institute. READ MORE: Study finds Canada’s healthcare wait times hit longest ever recorded“The results of this year’s survey indicate that COVID-19 and related hospital closures have exacerbated, but are not the cause, of Canada’s historic wait times challenges,” said Fraser Institute Centre for Health Policy Studies Director and study co-author Bacchus Barua. The Fraser Institute said Canada has a median wait time of 27.4 weeks — longer than the wait of 25.6 weeks reported in 2021. It said this wait time is 195% higher than the 9.3 weeks recorded in 1993 when it began tracking.
