Table 1.

Comparing the Features of the Models in 2005–2006

Characteristic	Community Health CENTER (CHC)	Fee for Service (FFS)	Family Health Groups (FHG)^a	Family Health Network (FHN)	Health Service Organization (HSO)
Adapted from https://www.oma.org/PC/PCRComparisonJan0807.pdf (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 introduced	1970s	–	2004	2001	1970s
Group size	Group practice, size unspecified	1 Physician	Minimum 3	Minimum 3	Minimum 3
Physician remuneration	Salary	FFS	FFS and incentives	Capitation^b with a 10% FFS component, and incentives	Capitation^b and incentives
Patient enrollment	Required	Not required	Required	Required	Required
	No roster size limit		No roster size limit	Disincentive to enroll >2,400^c	Disincentive to enroll >2,400^c
Access	No specified requirements	No specified requirements	THAS	THAS	THAS
			Extended hours^e	Extended hours^d	Extended hours^d
				Access bonuse^e	Access negation^f
Multidisciplinarity^g	Extensive	None	None	Some	Some
Assistance for information technology	Some	None	None	Yes	None
Objectives/priorities	Responsiveness to population needs, multidisciplinarity, prevention, focus on underserved, community governed¹⁸	–	Accessibility¹⁹	Accessibility, comprehensiveness, doctor- nurse collaboration, use of technology	Responsiveness to population needs, multidisciplinarity, health promotion, cost effectiveness²⁰