Canadian patients, particularly more vulnerable patients, are experiencing difficulties in accessing and securing affiliations with regular primary care physicians. To respond to this challenge, four Canadian provinces have created centralized waiting lists to better coordinate primary care medical resources: Health Care Connect in Ontario, Healthcare NB in New Brunswick, A GP for Me in British Columbia, and the Guichet d'accès aux clientèles orphelines (GACO) in Quebec. These waiting lists centralize requests for family physicians in a given territory and match unattached patients with family physicians based on a priority scale and on the availability of primary care resources. In those four Canadian provinces, the enrolment of unattached clients through centralized waiting lists is facilitated through financial incentives for physicians.
In 2008, the Quebec government mandated the province’s 94 health and social services centres (CSSSs) to implement waiting lists for orphan (unaffiliated) patients (GACOs) in their organizations. The objective of the GACOs was to increase the number of patients enrolled with family physicians and to prioritize vulnerable patients.
Intense media coverage of the issue of orphan patients and the Quebec Federation of General Practitioners (FMOQ) played a significant role in this reform’s conceptualization and implementation. Few guidelines were provided for this reform, so each CSSS had considerable flexibility in its implementation strategies. This latitude at the local level led to variation in the GACOs’ service offering, resulting in inequities in services for the population. Since their implementation, the financial incentives provided to encourage family physicians’ participation have been modified twice (November 2011 and June 2013) to facilitate, in particular, enrolment of the more vulnerable patients through GACOs.
A research team has studied the monitoring of GACO performance in Quebec since the inception of the reform. The results showed that nearly 890,000 residents of Quebec had been enrolled with family physicians through GACOs since their inception, and nearly 230,000 patients—including 60,000 considered vulnerable—were currently registered with a GACO and waiting to be matched with a family physician. The policy’s prime objective of increasing the number of people enrolled with a family physician was largely achieved. Since the GACOs’ implementation, nearly 10.9% of Quebec’s population had become enrolled with a family physician.
However, the study has shown that, despite a significant differential between the financial incentives for vulnerable and non-vulnerable patients, more than 70% of patients enrolled with family physicians through GACOs were non-vulnerable and came mainly through self-referrals by family physicians. Nevertheless, in their efforts to reduce the number of persons without a family physician, GACOs are addressing an important problem.
For an analysis of this reform, see: https://escarpmentpress.org/hro-ors/article/view/1188