Registering patients and paying capitation in family practice

It may surprise British doctors to learn that universal registration of citizens for primary care is controversial and exists almost nowhere else in the world. They might ask: “How can one take responsibility for a patient's preventive care, and for facilitating appropriate use of community services and referred care, without a defined list of patients?” Indeed, unsatisfactory answers to such questions, implying a less than adequate primary care system, have provided impetus for considering patient registration in other countries.1 We use the current controversy in Canada to explore the issue. Currently, primary care in Canada is delivered on a fee for service basis by doctors operating privately in solo or group practices. These doctors have no contractual obligations to government payers with regard to location, the mix of services provided, or the organisation of the practice. Although some special arrangements exist to improve the geographical distribution of doctors or to experiment with capitation payment or health centre models,2 these cover less than 5% of the population. Canada's federal and provincial governments and its doctors support the idea of changing to a system based on registration. But they have also expressed their concerns.3 4 5 6 The present debate centres on a report on the funding and reorganisation of primary care that was released for consultation this autumn by the federal, territorial, and provincial committee advising the government on health services.7 The details of the model proposed by the committee are less important than the principles: to move away from fee for …