Table 1.

Comparing the Features of the Models in 2005–2006

CharacteristicCommunity Health CENTER (CHC)Fee for Service (FFS)Family Health Groups (FHG)aFamily Health Network (FHN)Health Service Organization (HSO)
Adapted from (PCRComparisonJan0807.pdf).
THAS = Telephone Health Advisory Service, a patient telephone advisory system for which physicians are required to provide on-call services 24 hours a day, 7 days a week.
aLate in 2004, the Ontario Ministry of Health (MOH) created a new model of care, the FHG, to which FFS practices could transition. A family health group (FHG) is a collaborative comprehensive primary care delivery model involving 3 or more physicians practicing together. These physicians need not be located in the same physical office space, but must be within reasonable distance of each other. FFS practices converted to this new model quickly, so that by early 2006 most FFS practices had become FHGs, and it became evident that the great majority would transition by the year end.
bUnder capitation remuneration, family physicians received a fixed monthly fee per patient enrolled, independent of the number of visits made to the practice by that patient. The capitation fee is based on the enrolled patient sex and age. FHN physicians receive an additional 10% of the FFS structure for each visit. The latter is intended to allow better monitoring of services delivered. In 2008 all HSO were converted to family health organizations. Under that model, the practices today also receive 10% of the FFS structure for each visit.
cThe base capitation rate is reduced to 50% for patients enrolled to a clinician with a practice size exceeding 2,400.
dEach physician is required to provide at least 1, 3-hour session outside regular hours (evening/weekend) per week (up to 5 sessions per group/network/organization).
eAn incentive bonus reduced in relation to number of visits patients make to nonspecialists outside the FHN.
fA penalty incurred from the capitation fee for visits patients make to nonspecialists outside the FHN. Today, HSO practices are eligible for the access bonus are not subject to negation.
gMultidisciplinarity refers to the presence of allied health professionals (eg, physiotherapist, social worker, and pharmacist), excluding nursing staff, but including nurse-practitioners.
Year introduced1970s200420011970s
Group sizeGroup practice, size unspecified1 PhysicianMinimum 3Minimum 3Minimum 3
Physician remunerationSalaryFFSFFS and incentivesCapitationb with a 10% FFS component, and incentivesCapitationb and incentives
Patient enrollmentRequiredNot requiredRequiredRequiredRequired
No roster size limitNo roster size limitDisincentive to enroll >2,400cDisincentive to enroll >2,400c
AccessNo specified requirementsNo specified requirementsTHASTHASTHAS
Extended hourseExtended hoursdExtended hoursd
Access bonuseeAccess negationf
Assistance for information technologySomeNoneNoneYesNone
Objectives/prioritiesResponsiveness to population needs, multidisciplinarity, prevention, focus on underserved, community governed18Accessibility19Accessibility, comprehensiveness, doctor- nurse collaboration, use of technologyResponsiveness to population needs, multidisciplinarity, health promotion, cost effectiveness20