Transparency Grade: F
Overall Performance FY2023-2024
What's the data showing?
Obtained via FOI, this shows a breakdown of costs, recruitment and visits for BC's UPCCs. These health authority operated clinics were originally supposed to provide ongoing primary care (i.e., attachment), episodic primary care for unattached patients, and urgent care (to reduce ER visits), all using a team-based care model.
Promises were made that information on UPCC performance would be regularly reported to the public, but this hasn't happened.
UPCC cost per "visit": $182.50
Total Cost: $130,734,313
Overhead Cost: 30.82%
Total Visits: 716,347
Large variation between different sites.
See also: UPCC Staffing
What's the opportunity?
A lot of money and resources have been devoted to UPCCs, often at the expense of independent primary care clinics. UPCCs have not met their goals, are inefficient, have high overhead (greatly exceeding budgets), provide limited care, and are far more costly. Lack of public scrutiny has enabled this poor use of resources.
There have been significant concerns about management and clinical policies, as well as the "divide and conquer" model of team-based care they offer. This is reflected in the difficulty staffing them with primary care providers (physicians and nurse practitioners).
Overhauling them or (better) turning their operation over to management with familiarity operating primary care clinics (vs. large hospitals) would make far better use of the resources.
Do UPCCs attach patients?
They were supposed to. And the announcements continue to emphasize how many patients UPCCs will eventually attach.
But half don't attach patients to primary care providers at all.
For those that do, it's not many (<20k total, or 0.35% of BC's population).
And those in VCH are getting out of it entirely.
At least they're giving up the charade.
Now they just need to take the claims about attachment out of the press releases.
Sources
(for comparison)
UPCC FY2022-2023 cost data [source]
UPCC FY2022-2023 visit/staffing data [source]
FOI Requests
UPCC FY2023-2024 cost data [source]
UPCC FY2023-2024 visit/staffing data [source]
FOI data in Excel [data incorporated from above FOI requests]
Limitations
Three UPCCs pay physicians via FFS rather than on contract, so those expenditures are not included here. Also not included is startup capital costs, usually in the range of several million per site. That means the actual cost per visit is higher than shown above. The charts also exclude visit data from Comox Valley, Langley, and Chilliwack (new sites in the startup phase who had < 2000 visits).
Extensive notes in the FOI documents provide further context and details to interpret the data. The analysis (interpretive report, web page) is constrained by the limited information the government has chosen to make public. The analysis was independently produced; no funding was received from any political party, special interest group, etc.
How have things changed from the previous year?
Comparing the data year-over-year raises some disturbing questions…
- Why are costs up by 46% but visits only by 3%? Where is that money going?
- Why is overhead 36% over budget? Is anyone paying attention to costs?
- Why were so many nurses hired that they now exceed budget by 24%? Could they be better used elsewhere, like ER's?
- Why are there about TWO nurses for every family physician and nurse practitioner (many more in some UPCCs)? As they can't diagnose, order tests, refer to specialists, prescribe medications, and perform many other primary care tasks, why are so many needed? They're NOT making up for the shortfall in hiring FPs/NPs.
Note: spending on FPs/NPs is $43M and nurses $38M, but FPs/NPs cost much more than nurses.
| FY2022-2023 | FY2023-2024 | Change | ||
|---|---|---|---|---|
| Total Operating Costs | $89,658,180 | $130,734,213 | +45.81% | 3.1% over budget |
| Family physicians | $22,335,487 | $32,799,656 | +46.85% | 15.02% under budget |
| Nurse practitioners | $6,748,420 | $10,493,645 | +55.50% | 15.48% under budget |
| Nursing | $20,531,791 | $37,953,373 | +84.85% | 23.75% OVER budget |
| Overhead | $28,790,918 | $40,290,765 | +39.94% | 35.61% OVER budget |
| Visits | 694,745 | 716,347 | + 3.11% | |
| Cost per visit | $129.05 | $182.50 | +41.42% | |
| Overhead per visit | $41.44 | $56.24 | +35.71% |
How does UPCC performance compare with…
Independent primary care clinics? Family doctors under fee-for-service bill the government $35.83, while those working on the Longitudinal Family Practice model bill $57.50 for a 15min visit. These costs include all overhead. The average UPCC cost per visit of $129 is significantly higher.
Overhead costs alone often exceeded what independent physicians can bill for services.
What's missing?
There is currently no public reporting on UPCC performance. All of this data required FOI requests to obtain.
As noted in the UPCC Staffing page, a breakdown of what constitutes a UPCC "visit" in this data has been withheld (e.g., visit with which staff, and how many "visits" are associated with each patient's appointment).
Data on patient attachment has also not been made available.