Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

The Article in Brief

Those Left Behind From Voluntary Medical Home Reforms in Ontario, Canada

Tara Kiran , and colleagues

Background Seeking to improve health outcomes and reduce costs, more than three-quarters of family physicians in Ontario, Canada, voluntarily transitioned from traditional fee-for-service practices to medical homes over the past decade. However, approximately one in six Ontarians are still enrolled in fee-for service practices. This study seeks to understand the characteristics and quality of care of patients who did not participate in the voluntary transition to medical homes.

What This Study Found Patients who did not participate in the voluntary transition to medical homes, are more likely to be poor, urban, and have immigrated in the last 10 years, and less likely to receive recommended screening services, compared to patients in medical homes. Those patients with a fee-for-service physician are less likely to receive recommended testing for diabetes and less likely to receive screening for cervical, breast, and colorectal cancer, compared to patients with a medical home physician. (The authors note these differences in quality of care preceded medial home reforms.) Physicians who chose not to transition to a medical home were more likely to be older, to be international medical graduates and have smaller panel sizes.

Implications

• The authors call for strategies to improve care for patients left behind by medical home reforms in Ontario through improved connection to primary care or improved services with their existing physician.