Reviving full-service family practice in British Columbia.

In 2003, British Columbia created a joint committee of doctors and government representatives to reverse the deterioration in full-service family practice, particularly evidenced in poor morale among family physicians. The committee introduced an array of innovative programs into the province's fee-for-service system of solo and small-group practices, focusing on operational rather than structural changes. Incentive payments for managing chronically ill patients were followed by maternity care bonuses, training to enhance clinical skills and to support practice redesign, recruitment incentives for new family doctors, and other patient care initiatives. The programs, which are open to all general practitioners, have reduced health care spending on high-needs patients, research shows. Moreover, British Columbia now has the lowest hospitalization rate in Canada for seven medical conditions. The experience dem­onstrates that coordinated, operational reform of full-service family practice can improve care and reduce costs without radical restructuring of the primary care system.