Commission on the Reform of Ontario's Public Services

Recommendation 5-50: Use data from the Health-Based Allocation Model (HBAM) system to
set appropriate compensation for procedures and cease the use of average costs to set
hospital payments (see Recommendations 5-17 and 5-73 for more details on HBAM).
Recommendation 5-51: Create a blend of activity-based funding (i.e., funding related to
interventions or outcomes) and base funding managed through accountability agreements.
Recommendation 5-52: Create policies to move people away from inpatient acute care
settings by shifting access to the health care system away from emergency rooms and
towards community care (i.e., walk-in clinics and Family Health Teams), home care and,
in some cases, long-term care.
Recommendation 5-53: Encourage hospitals to specialize so all are not trying to provide all
services regardless of their comparative advantages.
Recommendation 5-54: Given the burden of alternate level of care (ALC) patients on hospital
capacity, hospitals must become more effective in optimizing this capacity while applying best
practices in planning patient discharges. Further, small hospitals with large ALC populations
must be assessed with a goal of redefining their role in care for the elderly. Again, funding
should be aligned appropriately.
Recommendation 5-55: Use hospitalist physicians to co-ordinate inpatient care from
admission to discharge. Hospitalists should work with Family Health Teams to better
co-ordinate a patient’s moves through the health care continuum (acute care, rehabilitation,
long-term care, community care and home care).
Recommendation 5-56: Make primary care a focal point in a new, integrated health model.
Recommendation 5-57: Regional health authorities must integrate physicians into a rostered
health system and adopt the appropriate measures to address compensation issues across
disciplines; that is, the proper blend of salary/capitation and fee-for-service.
Recommendation 5-58: Reduce the sole proprietorship nature of the offices of many primary
care physicians and encourage more interdisciplinary integration through performance
incentives and accountability.
Recommendation 5-59: Compensate physicians using a blended model of salary/capitation
and fee-for-service; the right balance is probably in the area of 70 per cent salary/capitation
and 30 per cent fee-for-service.
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