| In this analysis I examine the history of primary care in Ontario and focus on the utilization control mechanisms introduced in this Province in the 1980s and 1990s, and the physician-induced demand hypothesis on which they were based. I question the underlying theoretical premise, as well as the analysis done before their introduction, and review the impact they had on the primary care reform initiatives examined. I assert such analysis was inadequate and based on an incomplete model of physician behaviour. I examine the primary care reform initiatives introduced by the Conservative Government starting in 2000, outline the design parameters on which these reforms were based, review similar reforms in three other jurisdictions and attempt to explain why these initiatives failed to achieve the 80% acceptance originally intended. Based on the lessons learned I make six recommendations, one of them outlining how I propose these reforms should be continued. |
