Research Project

Primary Health Care in BC

Physician Supply, Distribution and Practice Collocation (1996/97 to 2004/05)

Primary health care (PHC) is the foundation of Canada’s health care system. For most people, PHC is their first point of contact with the health care system, often through a family doctor. It is where short-term health issues are resolved and the majority of chronic health conditions are managed. It is also were health promotion and education efforts are undertaken, and where patients in need of more specialized services are connected to secondary care.

Evidence indicates that strong PHC systems improve population health, reduce health disparities and buffer the health effects of socio-economic circumstances at lower cost than health systems that rely more extensively on secondary and tertiary care. Higher ratios of PHC physicians to population, and higher ratios of PHC physicians to specialists, result in better health outcomes. Practice composition may also impact the quality of care delivered by PHC physicians, and recent initiatives have encouraged multidisciplinary care (physicians working with other providers to offer more responsive, integrated and comprehensive care) in this sector.

Accurate data on PHC resources lays the foundation for meaningful discussion, evaluation and planning of physician supply, health service distribution, practice composition, and ultimately, health care renewal. But getting that data and using it to create valid information—determining who and where British Columbia’s physicians are, what services they provide, and their practice composition—is often more difficult than it sounds.

By developing new analytic techniques, researchers at CHSPR have compiled what might be the most accurate picture of the supply, distribution and characteristics of physicians in British Columbia. The work highlights recent trends from 1996/07 and 2004/05, and by developing a sophisticated, validated information system, lays the foundation for continued policy-relevant research into the attributes and qualities of BC’s PHC system.

Key Findings

  • As the amount of alternative funding grows in British Columbia, the completeness of fee-for-services (FFS) data as a source of population-based information decreases.
  • The vast majority (97%) of physicians in clinical practice in the province can be identified using FFS records. However, two-thirds of physicians not identified in FFS records can be identified through hospital discharge and transfer records. Combining traditional FFS data and hospital data offers the most efficient way to improve estimates of physician supply in British Columbia, and across many jurisdictions.
  • The increase in proportion of total physician expenditures attributable to alternative funding between 1996/97 and 2004/05 has eroded our ability to understand what services physicians provide.
  • British Columbia’s per capita supply of PHC physicians dropped by five per cent between 1996/97 and 2000/01, and rebounded by four per cent between 2000/01 and 2004/05.
  • The proportion of PHC physicians to total physician supply in British Columbia declined from 55 per cent in 1996/97 to 51 per cent in 2004/05.
  • There was almost a two-fold variability in PHC physician supply across health authorities in 2004/05, with Vancouver Coastal Health Authority at 130 per 100,000 and Fraser Health Authority at 77 per 100,000. Diversity in demographic structure, population health status and socioeconomic conditions across regions requires that services be tailored to meet local needs.
  • No link was found between the geographic distribution of PHC physicians and premature mortality rates--one of the best indicators of a population’s general health. But, prior research at CHSPR determined that per capita expenditures on general practitioner services are strongly related to premature mortality rate. So while PHC physicians may not be distributed geographically to reflect a population’s need for health care, people do cross jurisdictional boundaries to get the care they need.
  • There was a modest increase in the number of community-based group practices providing PHC in British Columbia between 1996/97 and 2000/01, and a more significant decline in the number of single-physician practices over the same period.

Project Team

Funding

  • British Columbia Ministry of Health