Primary care reform in Manitoba, Canada, 2011–15: Balancing accountability and acceptability

An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change

“…Furthermore, those contractors enjoy signi cant legally protected autonomy when it comes both to treating their patients, and in their relationships with the rest of the health system. (35,55) In Alberta, as elsewhere in Canada, (16) this independent contractor status, and the autonomy it affords physicians, are legacies of decisions made in the 1960s as Canada's universal publicly funded healthcare system was put in place. (16,22) These legal legacies are overlain by a western Canadian frontier narrative, as well as professional and operational cultures that valorize the ideal of lone generalists enjoying long term relationships with their patients.…”

“…(56, 57) Given this admixture of law and culture it is perhaps unsurprising that these independent contractors, or 'non-system' members of the Canadian health system, have proved resistant to 'system' changes. (16,55) While Alberta and Canada will be idiosyncratic in some ways, this clash between the cultures of physician and system is a phenomena observed in jurisdictions around the world, even those with more command-and-control capacity. (58,59) Acknowledging this reality, policy makers aiming to achieve transformation towards PHC have focused on voluntary, discretionary, participatory, and incentivising mechanisms to secure the buy-in of 'non- The culture of the PCNs, and so of their ercely independent physician members, has been transformed so that accounting to achieve the PMH, and concern for broader system narratives have become part of the conversation and moral calculus.…”

“…(13,19) Within this wide range of policy innovations, the nature and extent of progress have been variable across jurisdictions, and with limited exceptions, (e.g. 19,20,21) provincial and territorial experiences have gone un-shared. (22) This is to say, with PHC transformation efforts taking place in Canada, and thus "outside the con nes of centrally managed integrated health systems,"(10) little attention has been paid to the successes and challenges encountered by those implementing policy.…”

“…With this lost opportunity for mutual learning in mind, this paper tracks the origins and evolution of Alberta's PCNs as mechanisms for accomplishing PHC. At a time when the concept of PCNs is gaining traction both within Canada, (20,23) and worldwide, (24) we describe the speci c details of Alberta's organizations as vectors for the transformation of primary care that have matured over the last 15 years. The PCNs' ability to survive and expand not just locally, but across an entire province in what has been described as a 'nation of pilot projects' (25) which seldom manage to achieve spread or scale, (26) is remarkable.…”

Effect of family doctor contract services on patient perceived quality of primary care in Southern China

“…It has been proven worldwide that a strong primary care delivery system is the foundation and guarantee of an efficient health care system, and an increasing number of countries are taking measures to strengthen their primary care capacity [1,2]. China's health care system reform of 2009 has given more attention and resources to the primary care system [3,4].…”