'Accountability & Metrics': The Key to Transforming Primary Health Care in Canada

The sustainability of publicly funded healthcare in Canada is under threat as healthcare spending is increasing faster than government revenues. This is driven by increasing utilization of health human resources, medical technologies and drugs for treating the growing burden of chronic disease.

 The burden of chronic disease can be reduced by addressing the underlying factors: nutrition, physical activity, alcohol, drug and tobacco use, employment, income, working conditions, injuries, social exclusion, early child development, education, housing and the environment.  Taking action in these areas will reduce inequities, improve population health and reduce healthcare expenditures.  The current primary care system in Canada now provides poor quality of care, limited access and poor value. A waste of resources and the cause of considerable public and professional dissatisfaction, the system needs to be changed.

 There is much evidence as to what is required to transform primary health care so that it not only could provide better care but could also better prevent chronic disease, improve population health, reduce inequities and reduce healthcare expenditures. A transformed and integrated primary healthcare system should:

• Serve a geographically defined population
• Provide comprehensive health services that range from primary prevention/health promotion and effective management through to end-of-life care.
• Have an interprofessional team of health professionals that includes those with an individual service focus (physicians, nurses, nurse practitioners, home care, etc.) and those who focus on population health (public health professionals).
• Have financial incentives aligned with expected outcomes (including increased investments in public health and prevention).
• Be supported by electronic data systems that are linked to quality improvement programs.
• Have a governance system enabling communication and accountability between the community and the provider team.

How can this transformation be achieved? Through the development of accountability mechanisms supported by ‘metrics’: appropriate indicators and databases and regular public reporting.