Primary care for all: Lessons for Canada from OECD countries with high primary care attachment
Author(s): Heba Shahaed, Richard H. Glazier, Michael Anderson, Erica Barbazza, Véronique LLC Box, Ingrid S. Saunes, Juha Auvinen, Maryam Daneshvarfard, Tara Kiran
Description:
Strong primary care enables better outcomes for patients, lower costs and better equity. In Canada, approximately 1 in 5 people report not having access to a family doctor or other regular care provider. In addition to this, there are fewer medical students choosing to pursue family medicine, and more graduating family physicians are choosing not to practice generalist office-based care. We conducted an analysis to determine which OECD countries have high primary care attachment rates and what strategies they use to enable this. We consulted the 2020 Commonwealth Fund survey, European Observatory reports, and Commonwealth Fund Country Profiles which enabled us to identify nine countries with primary care attachment rates higher than 95%. These countries were compared to Canada on a range of country, health and health system characteristics. The UK, Norway, Netherlands and Finland were selected for a further deep dive supported by literature and health system experts. We learned that our selected OECD countries have stronger contractual agreements and accountability for family doctors including where they practice, their scope of practice, and who they accept. They also have a higher proportion of total health spending that is public, fewer family doctors who work in walk-in clinics or specialized areas, and a highly organized network for after-hours primary care. Payment is through capitation or salary, and there is highly effective use of interprofessional teams along with digital tools and information systems. There were several key lessons that can be taken away from our analysis that can help inform bold policy reform in Canada to enhance the current state of our primary care systems.