Primary Care Funding Comparison

INSTRUCTIONS: Hover over each item for a brief explanation. Explanations are also found below, often with additional details. Note numbers correspond to table cells, like in a spreadsheet (1A = row 1, first column). Will add additional notes with further details in future. For now, consult other resources on this site, e.g. FAQ.

	A. Current FFS not incl/ one-off bailouts	B. UPCC govt clinics ("DixCare")	C. Modernized FFS w/ time-based fees	D. Longitudinal Family Practice (LFP) model
1. Cost per typical patient visit	$31	$125, $205, >$250?	~$70	~$79
2. Capacity to accommodate patient volumes	Fair → Poor	Poor	Good	Fair
3. Wait times for appointments	Fair → Poor	Fair	Good	Fair
4. Reduces load on ER and specialists	Fair → Poor	Poor	Good	Fair
5. Supports appropriate length visits	Poor	Good	Good	Fair
6. Supports time for documentation.	Poor	Good	Fair	Fair
7. Financially supports family doctors	Poor	Good	Good	Fair
8. Support from family doctors	Poor	Fair	Excellent	Fair
9. Support from government	Fair	Excellent	NONE	Excellent
10. Independent accountability	Good	Poor	Good	Good
11. Authority over patient care decisions	Patients Physicians	Patients Physicians Allied Health Administrators	Patients Physicians	Patients Physicians

Notes:

1A.: Fixed fee for standard visit regardless of length, so most visits are short.
1B.: Full data for performance and costs for UPCCs have not been released by the government or health authorities to the public. Based on data obtained for Victoria-area UPCCs, I have come up with the $205 per-visit fee as follows. Note that UPCCs rely on a heavily fixed cost model (vs. variable cost for FFS), and the costs do vary somewhat depending on the size of each facility, etc. I have assumed a fixed annual operating cost of $3 million per facility. As a comparison, the Westshore UPCC operating budget is closer to $4.5 million. I have assumed average patient throughput of 40 visits per day, so 14600 visits per year. Daily average encounters per month for the eight Victoria-area UPCCs vary widely, often reflecting staffing issues, from lows of <2 visits per day on average for a month to a high of 65, with a median of 30–35. Even assuming 65 visits and $3m operating costs, that's still $126 per visit.
1C.: The details of time-based fees for family doctors would still need to be sorted out, though good models exist, both in BC (e.g., how psychiatrists' fee codes work), and in other provinces (e.g., AB). For simplicity, I'm assuming time-based fees of $35/10min, with an average appointment length of 20 minutes (some will be shorter, some longer).
1D.: Assume three appointments per hour plus 15min of paperwork. So for three appointments, (3 x $25 visit fees + 1.25 x $130 time fee) / 3. More appointments per hour decrease the per-appointment rate. Does not include attachment fees.
2A.: Capacity is quickly decreasing as more independent clinics close.
2B.: Despite tremendous investment, a very small number of patients are seen each day compared with independent clinics.
2C.: With appropriate compensation, would bring more doctors back to longitudinal family practice and less repeat visits for unsolved problems.
2D.: LFP has encouraged many family doctors to continue with family practice, though too many continue to find it unworkable.
3A.: Growing longer as clinics close, panels are maxed out, and system delays spread.
3B.: Often same-day appointments but limited number and requires lineups and persistence.
3C.: With appropriate compensation, would bring more doctors back to longitudinal family practice and less repeat visits for unsolved problems.
3D.: LFP has encouraged many family doctors to continue with family practice, though too many continue to find it unworkable.
4A.: Episodic care results in fewer problems treated early in primary care, becoming more acute or creating backlogs.
4B.: Episodic care results in fewer problems treated early in primary care, becoming more acute or creating backlogs.
4C.: Longitudinal care treats problems earlier, before they become acute, and relies on specialists less often.
4D.: LFP encourages more patient attachment, but still incentivizes short appointments and thereby more referrals.
5A.: Payment model forces appointments to be short.
5B.: Payment model allows longer appointments when needed.
5C.: Payment model allows longer appointments when needed.
5D.: LFP still incentivizes short appointments, though it reduces the financial penalty if extra time is spent.
6A.: Most family doctors spend many extra hours per day completing paperwork after seeing patients.
6B.: Doctors are paid on an hourly basis which covers time for required paperwork.
6C.: Longer appointments allow more documentation to be completed during appointments.
6D.: Time for documentation outside appointments is compensated, though at much lower rates (less than a paralegal would bill).
7A.: Covering overhead and providing a modest income impossible if providing acceptable level of care.
7B.: Service contracts provide a predictable income for a specific amount of work.
7C.: Compensates physicians for time spent with patients to provide acceptable care, covers overhead, and provides acceptable income.
7D.: Better direct compensation for patient care and admin, but rates too low to support overhead. For those in HCOL areas, LFP eliminated business cost premium (BCP) support.
8A.: Family doctors have nothing else to sacrifice; truly independent family practice will not survive without change.
8B.: While in theory a good fit for many, recruitment and retention has been very poor, reflecting physician concerns.
8C.: Most family doctors would prefer this option, sufficiently supporting their choices on how to run practices or delegate to others.
8D.: Many greatly prefer this to classic FFS, but many others do not find it would support a financially competitive family practice.
9A.: Government has not moved to remove FFS altogether, though prefers contracts.
9B.: Government has bet 100% on this, providing far better compensation than alternatives.
9C.: Government has unilaterally refused to consider this option.
9D.: Government has been pushing this hard.
10A.: Doctors' billings are public, can be reviewed and audited by CPSBC and MSP.
10B.: Performance and cost measures withheld by government.
10C.: Doctors' billings are public, can be reviewed and audited by CPSBC and MSP.
10D.: Doctors' billings are public, can be reviewed and audited by CPSBC and MSP.
11A.: Both parties have full autonomy.
11B.: Government-run clinics offering team-based care without mandatory physician oversight of all care decisions and policies.
11C.: Both parties have full autonomy.
11D.: Both parties have full autonomy.