Submission ID 131852
| Issue/Objective | Primary care reform in Ontario prioritizes patient attachment, positioning rostering to a regular provider as a central indicator of system performance. However, attachment does not equate to equitable access to care. This is particularly evident for equity-deserved populations, including refugees and migrants, whose health needs are shaped by complex social and structural factors. Attachment-based approaches inadequately capture whether care is timely, continuous, coordinated, or responsive to these needs. This study argues that attachment, as currently operationalized, is an insufficient measure of access and obscures persistent inequities in primary care delivery. |
|---|---|
| Methodology/Approach | This study employs a health policy and systems analysis informed by document review, secondary data, and conceptual synthesis of primary care access, continuity, and equity frameworks. It examines how attachment is defined and measured within Ontario's reform agenda and how this shapes policy priorities and system accountability. Community Health Centres (CHCs) are examined as a case example of equity-oriented care, illustrating how alternative, team-based models, characterized by global budgets, interdisciplinary teams, and community governance, move beyond traditional physician-centric approaches to address complex and socially mediated health needs. |
| Results | Findings suggest that attachment-focused reforms risk conflating enrollment with meaningful access to care. For refugees and other equity-deserving populations, attachment does not ensure continuity, coordination, or responsiveness to complex health and social needs. In contrast, CHCs demonstrate how team-based care models designed around continuity, through sustained relationships, coordinated care, and responsiveness to social context, can better support equitable access. However, these models remain peripheral within mainstream primary care reform. |
| Discussion/Conclusion | Reframing primary care access requires moving beyond attachment toward a focus on equity and continuity. Integrating equity-oriented, team-based models such as CHCs as core system infrastructure is essential for delivering meaningful and equitable access to care. These findings have broader relevance for health systems seeking to improve care for equity deserving populations in complex and evolving contexts, particularly in settings shaped by migration, displacement, and health system strain. If attachment is our measure of success, we risk mistaking enrollment for equity, and leaving those with the greatest needs without meaningful access to care. |
| Presenters and Affiliations | Abisha Yogaratnam McMaster University Meredith Vanstone McMaster University Amanda Sim McMaster University |
