There are two major challenges related to funding models/financial incentives supporting collaboration:

  • The current fee-for-service payment model in primary care is a disincentive to collaborate;
  • Increased financial investment is needed for collaboration, not just reallocation of funds.

Current Fee-for-Service Payment Model is a disincentive
In addition, competition for services that could be delivered by either public health or primary care (e.g., immunizations, well-baby checks) can be created. Thus, in more urban areas, where the ratio of providers (both public health and primary care) to population is lower, collaboration between public health and primary care could be scarce.

ListenHear a short discussion between two policy makers in government debating these commonly seen challenges related to funding

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This interchange between policy makers highlights the complex relationship between this factor – funding models/financial incentives – with an interpersonal factor- trusting and inclusive relationships.

Related IconRelated: Trusting and Inclusive Relationships



Increased Financial Investment
Increased financial investment is necessary. Attempts to address it are helpful but not sufficient including as follows:

  • Secondments of health human resources to strengthen collaboration between public health and primary care;
  • A portfolio that includes both public health and primary care sectors.

Related IconRelated: Optimal Use of Human Resources



It is scarce and dwindling resources that often inhibit collaboration because people are competing for limited funds. Strengthening collaboration between public health and primary care requires increased provincial or territorial funding or redirected funding to create a supportive infrastructure: This can support shared physical space, common information and communication systems such as shared electronic health records systems, and education of new graduates in both public health and primary care.

Increased investment is needed for utilizing health human resources in different ways.

For example, public health nurses and community dietitians attending pre-natal group medical visits offered in primary care practices can collaborate on the following:

  • Contributing to birth registry services,
  • Providing advice on healthy eating in pregnancy,
  • Making connections with moms-to-be,
  • Assessing for those at high risk for post-partum depression.

For these kinds of collaboration between public health and primary care to occur, investment would need to be made provide adequate space and financial incentives to hold group medical visits for primary care as well as public health to attend evening group visits.

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