Does the Longitudinal Family Physician Payment Model improve health care including sustainability?

The aim of the Longitudinal Family Physician Payment Model is to provide enhanced primary care for all British Columbians. It addresses the lost capacity caused by inadequate remuneration and poor worklife conditions. Its innovative approach triples net remuneration, which has the potential to restore the productivity of existing family physicians to their 44% greater average number of patients per physician of a decade ago. It remains to be seen how much of the loss was due the introduction of electronic medical record keeping during that decade. Capacity is further stimulated by making family medicine a more attractive career choice. From an overall health care improvement perspective, the increased time per patient permits greater use of traditional physician skills, which fulfills both the first and second of the quadruple aims: improving the health of populations and enhancing the patient experience of care. The third aim, reducing per capita cost, may occur through the use of fewer tests, investigations, and referrals, and the prevention of more complicated downstream interventions. The Ministry of Health expects to achieve those goals through the fourth aim: improving the working life of health care providers. As such, the new model holds the promise of a return to the family physicians of yore: available, accomplished, affable, and admired. However, it does not include incentives to build primary care teams to increase capacity or specific incentives to be more frugal with the resources put at the disposal of clinicians. It is also silent on how contiguous primary care is to be provided on a 24-hour basis, 7 days per week. Also missing is a projection of how to sustain the increased expenses and find the funds for the much-needed upgrading of secondary and tertiary medical care. Compared with the countries of mainland northwestern Europe, British Columbia's MSP costs are similar, but fewer goods and services are delivered. This raises the question of whether we can afford to introduce new programs that may not be sustainable. The cause of the gap in benefits requires investigation and attempts to recover it if we wish to attain the world-leading status in medical care of our European colleagues.