Brian Hutchison, M.D., M.Sc., Jean-Frederic Levesque, M.D., Ph.D., Erin Strumpf, Ph.D., and Natalie Coyle, M.Sc.
B. Hutchison, J.-F. Levesque, E. Strumpf et al., "Primary Health Care in Canada: Systems in Motion," Milbank Quarterly, published online June 15, 2011.
In the 1980s and 1990s, innovations in the structure and delivery of primary care played a small role in Canada's health system, which stagnated as many other countries made advances in quality and access. A new, potentially transformative policy environment emerged in the early 2000s, however, as government expanded investments in the system. This study analyzed primary health care reform efforts in the country over the past decade, using literature reviews and interviews with experts.
Canada has undertaken substantial initiatives to improve access, quality, and coordination of primary care in its health system, which relies on public funding and private delivery of services. These changes include: the enrollment of patients with a primary provider, an expansion of the provider pool, the development of multidisciplinary primary care teams, and new payment arrangements. Physician involvement has been voluntary, and certain jurisdictions negotiated broad changes with provincial medical associations.
The initiatives implemented in Canada suggest that primary care can be transformed through a voluntary, incremental process in which government and private, professional leaders collaborate. The efforts also show that a single-payer, publicly funded system "need not be the enemy of health care reform, innovation, and quality improvement."