Detailed cost or performance measures for UPCCs have been hard to come by. We're fed "positive" statistics about the total number of visits, e.g., this Feb/2024 media release quoting 2.37 million visits across all UPCCs as of Dec/2023. It sounds impressive. Is it?
Two recent Freedom of Information (FOI) requests tell the story. While not a detailed accounting and leaving many questions unanswered, they give us the better picture yet. The data covers one year, from Apr 1/2022 to Mar 31/2023 (FY2022-23).
Full details at bcupcc.ca/performance.
Based on Government FOI data from Apr 1/2022 to Mar 31/2023 (FY2022-23):
Total Cost1 | Number of Visits2 |
$89.7 million | 694,745 |
Average cost per UPCC visit:
$129
Compare that with the cost of a non-UPCC family doctor visit:
$35.83 (FFS3) or $57.50 (LFP4)
Those 700k visits should cost closer to $30 million — not $90 million!
1 Some UPCC costs are not included due to limitations in the available source data. Some independent clinics are eligible for additional supports. So the actual average costs (both UPCC and independent) are slightly higher. See report interpretation notes for details.
2 Visits include seeing a doctor, nurse practitioner, nurse, or counsellor. One "visit" to a UPCC may generate multiple "vists" in the data. See Who do you see at a UPCC, below.
3 Fee-For-Service (FFS) office visit to a family doctor for patient age 2-49 (fee code 00100). Fees cover physician time, overhead, nursing, and other staff. If nursing or other staff is involved, no additional fees can be claimed.
4 Represents a standard patient visit service and 15-minutes of physician time for a family physician, under the longitudinal family practice (LFP) payment model. As with FFS visits, includes all overhead and staff, with no additional billing when patients seen by other staff.
Overhead is 32% of UPCC costs:
That's more than an entire family doctor visit (FFS)!
Nine UPCCs pay more for overhead than an entire 15min LFP visit.
Average overhead:
Three UPCCs spent more than double!
What are UPCC "visits" anyway?
Seeing a doctor or nurse practitioner at a UPCC counts as a visit.
But so does going to a UPCC and seeing a nurse (who can't diagnose, prescribe, refer, …).
Or seeing a counsellor.
And you'll more likely see a nurse.
Because many UPCCs are very understaffed. Particularly with doctors and nurse practitioners.
That's why many often close or have no doctor available.
Primary care centres — without primary care.
Why? Doctors love team-based care. But not how it's done at UPCCs.
Many say it's broken, inefficient, and increases risks to patients.
And if you see a nurse and then a doctor? That may count as two visits at a UPCC!
The government has repeatedly refused to break down visits by profession (e.g., doctor, nurse). We need to know more about what a "visit" is — who it's with, for how long, and for what? All visits are not identical or interchangeable. If a patient visiting a UPCC can trigger multiple visits, how many patients are actually being seen?
Every UPCC provides a different mix of services and staff levels. Some are much more efficient and effective than others. It also seems that UPCCs in some health authorities generally do better than those in others.
Example: At the first UPCC (Westshore), cost/visit is $216 (vs. $129 average). Overhead is $89/visit (vs. $41). Total overhead is double what was budgeted (which you think they'd have figured out by now)! They only have about 3/4 of the doctors needed. That's better than some in Victoria (e.g., Esquimalt, North Quadra) who have less than half.
See below for more "highlights" and other questions raised by this data.
The original FOI data, an analysis report, and extensive commentary offering context and interpretation is found at:
The following is mirrored from that site for your convenience.
This detailed report provides a more user-friendly view of the most relevant FOI data, showing costs, visits, and recruitment, broken down by health authority and individual UPCC.
[PDF, 26 pages]
Catch a mistake? Something I missed? Please let me know.
Additional downloads:
Limitations:
Detailed cost data for Cranbrook and Penticton UPCCs was not available. Three UPCCs pay physicians via FFS rather than on contract, so those expenditures are not included here. That means the actual cost per visit is higher than shown above.
❌The government has repeatedly refused to give a breakdown of visits by profession (e.g., doctor, nurse, …) including how many patient visits include more than one "visit" in the data.
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.
Note: For more recent visit/recruitment data (not included in analysis here), see HTH-2024-40402 and HTH-2024-40744.
Why do we continue investing in UPCCs when the cost is so high?
At an average cost per visit of $129 (and more than $200 at one out of every four), how can you continue spending so much money for so little care? Why is that money not going to independently-operated clinics that are able to provide so much more care for the same cost? UPCCs are draining valuable financial and human resources we can't afford to waste. And why is this waste not only still going on after five years, but expanding? To say nothing of the longitudinal primary care that was promised, of which only a small fraction is being delivered.
Why do 70% of UPCCs have overhead costs that exceed the total fee for independent clinic visits?
If family doctors elsewhere are expected to bill $35.83 for a patient visit, which includes paying themselves, their staff, office expenses, and other overhead, why do the overhead costs at UPCCs average $41 per visit, with several spending more than double that on overhead?
How are independent clinics expected to operate?
If the actual cost to provide care is that high, how can the low rates provided to independent physicians be justified? Are they expected to provide worse care? And why are they required to provide more care to patients that UPCCs are not? Are independent clinics now dependent on additional government funding beyond what is covered by negotiated agreements, e.g., the Physician Master Agreement? Is each clinic expected to rely on one-off block funding that the government of the day can change or withdraw at any time, for any reason? How can clinics operate under such uncertainty, and how does this protect the public's access to essential primary care?
Why are so many UPCCs having so much difficulty recruiting family physicians and nurse practitioners?
While some appear to be hitting (or close to) their recruitment and retention targets, many others have a fraction of what they need. Why? How do you run a primary care clinic without a primary care provider available?
Do you really understand team-based care?
In BC, team-based care (TBC) has turned into a top-down, divide-and-conquer, accountability-free, HR marketing strategy. A collection of people alone does not make a team. Real TBC is based on shared purpose, shared goals, shared responsibility, shared accountability, collaboration, and mutual respect. Very different from the "buzzword" TBC used by MOH. Real teams leverage each other's skills and work together. An utterly foreign concept in BC. The piecemeal approach to primary care in BC is promoting more fragmentation and silos. In the end, that may bump up your stats for number of "visits." But when those visits don't accomplish what they need (generating the need for more visits), don't produce meaningful results, increase workloads elsewhere, and ignore everything we've learned about the value of continuity and relationships in healthcare, what is being accomplished?
What are you doing to encourage thousands of FPs and NPs doing other work to return to primary care?
Too many find they can't survive in primary care. They're stuck with fees that don't come close to covering their costs, whether under the "classic" fee-for-service model that hasn't changed in years, or the new longitudinal family practice model. Or they aren't willing to put up with the bureaucracy, medico-legal risk, and poorly-implemented team-based care model provided by government-managed UPCCs. Instead, they're doing anything but primary care, especially non-MSP things like Botox, cosmetic lumps and bumps, and so on. Given the government's apparent willingness to pay large sums for primary care services (if at a UPCC), why aren't you doing more to shift many of the thousands of family doctors in BC working outside primary care back to where they're most needed?
Why are there so many nurses in UPCCs compared with family doctors or nurse practitioners?
Nurses are great, and are able to provide some valuable care, but there are many things they can't do, like make diagnoses, prescribe, and much more. If UPCCs are offering primary care services, nurses can't do it alone. How many times do patients see a nurse who can't help them with their problems because a physician or nurse practitioner is not available? How many times are UPCCs closed because of this? Independent clinics have fewer nurses because they can't bill the government for their services, so often rely on limited one-off funding. More nurses there could help provide more care. Want to improve clinic productivity? The ratio between nurses and primary care providers is important. Somewhere between independent clinics and UPCCs is the right balance.
Why are you continuing to announce and open new UPCCs when you can't staff the current ones?
In June/2024, three more UPCCs were announced in Island Health (Cowichan, a second for Nanaimo, and Comox Valley). This is in a health authority that has struggled to staff existing ones with primary care providers. It has consistently scored lowest when it comes to physician engagement (in 2023, only 25%). Island Health physicians don't feel leadership seeks or values their input and only 6% feel senior leadership decision-making is transparent. It's no surprise that so many people perceive these announcements and empty buildings as very expensive vote-generating exercises and not serious attempts to provide the necessary medical care patients need.
Why do more than half of UPCCs exceed their budgeted overhead by >10%? Why are three more than double?
Why are budgets for overhead at UPCCs so frequently exceeded? Is anyone keeping an eye on the finances? Is it acceptable for UPCC management to routinely overshoot their budgets? Then again, it's not their money, so doesn't cost them anything personally. There's always an unlimited amount of money available from taxpayers.
Why won't you disclose what services UPCCs are actually providing?
We need to know more about what a "visit" is — who is it with, for how long, and for what? All visits are not identical or interchangeable. If a patient visiting a UPCC can trigger multiple visits, how many patients are actually being seen?
Where is the data on attachment? On wait times to get seen? Those turned away?
It seems that many urgent and primary care centres can't provide either urgent or primary care. If you expect people to believe that UPCCs are anything more than political props, where are the meaningful performance metrics, the real targets that matter to patients?
How is it acceptable that such basic data requires FOI requests?
The BC public depends on adequate health care information. Instead, all they seem to get is spin and cherry-picked statistics from this government. Why is basic information — visits, staffing (capacity), and cost — not routinely available and regularly updated for the public?
Demand independent and mandatory reporting on our health system. The same organization that funds, manages, and operates the health system cannot be trusted to report on it too. Especially when there are political consequences for sharing bad news with the public.
The BC NDP have grossly mismanaged health care. Is changing government enough to fix this? Will BC Conservatives or BC United do better? No! Given free rein, they'd be a disaster too, just a different one. Because no government is accountable to the public or required to tell the full truth about taxpayer money spent and health services delivered.
To fix, strengthen, and protect our most treasured social program, we need an independent body with full, legally mandated access to report regularly on health system performance: access, outcomes, and financials. Start with a full public audit and inquiry of what's happened in health care over the last five years and where we are now. And don't trust any government to make sweeping changes without full transparency and accountability safeguards in place.
And make this a firm condition to support election candidates from any party.