Canada is trailing behind other Organisation for Economic Co-operation and Development (OECD) nations, when it comes to both the number of physicians relative to the population, and its spending on primary care, according to a new analysis published in the Canadian Medical Association Journal. Health systems with strong primary care have better results, less costs and better equity
Yet, even at the outset of the COVID-19 pandemic, about 17 per cent of individuals in Canada have reported that, they are not having a regular primary care clinician.
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Primary care for all: lessons for Canada from peer countries with high primary care attachment
In the meantime, the investigation reveals, that Canada is seeing a declining enrolment in family medicine as a specialty among medical students and more graduating family physicians are choosing not to practice generalist office-based care. Post-pandemic, in Canada 22 per cent of adults, which is more than 6.5 million individuals don’t have a family doctor which they can depend on regularly care.
To solve these problems, the authors say Canada should learn from the successes of other OECD nations with high rates of patients enrolled with primary care clinicians.
The authors compared Canada to nine nations where more than 95 per cent of individuals have a family doctor, primary care clinician or place of care including Norway, Finland, Italy, France, Netherlands, Germany, United Kingdom, New Zealand and Denmark to find opportunities for improvement here. To make their comparison, they studied data from 2018 to 2021.
They found that these nations tend to spend more on primary care, that a greater percentage of their health care is publicly funded, since they have more doctors overall and more of their family doctors are working in family practices.
In Canada, by contrast, most doctors work in emergency departments or practice in a certain area, like sports medicine.
Among the nine OECD nations, most doctors are paid by salary or a fixed payment method known as capitation, rather than the fee-for-service model, which is common in Canada.They have organized after-hours care and few or no publicly-funded walk-in clinics and they also have smarter information systems which allows doctors to better communicate better with patients and allow patients to find out their own records through online.
For primary care Canada spends less from its total health budget and spends more on private health care compared to any other countries.
Dr. Tara Kiran, a family physician at St. Michael’s Hospital and Unity Health Toronto mentioned that, other nations have designed their system, so that each and everyone has access to primary care and we need to do the same, and at the core, we need to make sure that there is access to primary care.
To bring Canada up to speed with the OECD nations providing the best primary care, the authors say public health care needs some important updates.
They also said that, most doctors in Canada are private contractors with little system accountability, whereas they need to be bound by stronger contractual agreements and accountability to government, insurers or both. They also call for changes to the way health-care providers are paid, mainly to move primary care physicians to capitation or salary payments and away from fee-for-service.
They suggest that a higher proportion of the total health budget been spent on primary care, with Medicare coverage extended to prescription medications, dental care and expanded mental health care and they also say that Canada needs more physicians per capita.
Canada should move to a model where people are guaranteed access to a primary care practice near their home and make sure that these practices are funded properly.
Finally, they call for improved patient communications systems, more organized after-hours care and less walk-in clinics.
They admit that factor is unique to Canada, such as its vast geography, diverse population and proximity to the United States and its health-care system, could pose challenges to emulating its foreign counterparts.
However, they say it’s already a partway there, with respect to regional funding of physician services by governments, overall health spending and the way primary care serves as an access point to other parts of the health system.
Canada can learn from OECD nations, where more than 95 per cent of individuals have a primary care clinician and these international examples can inform bold policy reform in Canada to advance a vision of primary care for all.
