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More doctors needed to treat disadvantaged: study

The province of Ontario’s efforts to improve access to family physicians has been successful, but the people who may need care most are not benefiting, according to a study led by St. Michael’s Hospital’s Dr. Rick Glazier.

Toronto, June 4, 2009

Dr. Rick Glazier Dr. Rick Glazier

The province of Ontario’s efforts to improve access to family physicians has been successful, but the people who may need care most are not benefiting, according to a study led by St. Michael’s Hospital’s Dr. Rick Glazier.

In order to address shortfalls in the medical system, the province introduced a capitation model in 2001 that essentially paid doctors a flat rate per patient. This was followed by an enhanced fee-for-service model in 2003, in which doctors could collect extra payments for working evenings and offering preventative care such as flu shots and mammograms.

While the capitation program has been successful in reducing the number of Ontarians without a family doctor, the patients that benefited tended to be healthier and wealthier than the average citizen.

“When you put resources into a system and you don't regulate how they are used, those who are better-off are best able to take advantage,” said Dr. Glazier, a researcher at the Centre for Inner City Health at the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital.

Dr. Glazier stressed that the changes have been beneficial, but that adjustments are needed to better address the needs of people with chronic health problems and the socially disadvantaged. In other countries where capitation models are used, doctors are given additional incentives to treat those with chronic illnesses and the poor.

"It's getting some very needed investments to improve access to care and quality of care,” Dr. Glazier explained to CBC News. “These plans still need some adjustment because they're not reaching low-income people."

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