Transforming Primary Care the Canadian Way: Successes, Challenges, Lessons Learned, and Next Steps

A joint Director-APHCRI-NCEPH seminar

Dr Rick Glazier is a Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences (ICES) in Toronto, Canada. He is also a Family Physician at St. Michael’s Hospital in Toronto and a Scientist in its Centre for Research on Inner City Health. At the University of Toronto, Dr. Glazier is a Professor in the Department of Family and Community Medicine, and is cross-appointed at the Dalla Lana School of Public Health. Dr. Glazier received his medical degree from the University of Western Ontario, Family Medicine residency training at Queen’s University and graduate education and residency in Public Health and Preventive Medicine at Johns Hopkins University.  He is currently President of the North American Primary Care Research Group (NAPCRG). His research focuses on primary care health services delivery models, chronic diseases management, health of disadvantaged populations, and improving equity in health.


Strong well-organized primary care systems are increasingly seen as fundamental to achieving the triple aim of better population health, excellent patient experience, and reasonable cost.  Despite this consensus, developed countries continue to struggle with the most effective ways to organize and pay primary care providers, incentivise desired behaviours and outcomes, harness information technologies, engage and empower patients, coordinate care for complex patients and integrate with other health care sectors. Canada’s 13 jurisdictions have taken remarkably different approaches to these challenges. Ontario, Canada’s most populous province, now has the majority of physicians and patients in organized models of care featuring blended reimbursement, after-hours responsibilities and pay-for-performance incentives, with many in inter-professional teams.  Most providers are pleased with these developments and there has been a growing preference for primary care by students, but some policy-makers find the changes to be costly, inequitable and not producing the value they counted on. This presentation will review the main challenges to primary care, discuss international comparisons and innovations, and describe the main features of Canadian and Ontario reforms. It will present evidence about the effectiveness, equity and impact of these changes in relation to issues of relevance to Australia and other developed countries.