Change doctors’ pay to cut health costs, reports says

TheStar.com – News/healthzone.ca
April 14, 2010.   Theresa Boyle, HEALTH REPORTER

The province should overhaul the way doctors are paid so that the profession gets a smaller chunk of healthcare funding, says a coalition of healthcare providers.

The bold recommendation is contained in a report, to be released Thursday, that calls for major changes to Ontario’s health system aimed at saving billions of taxpayer dollars.

The report, titled Bending the Cost Curve, was produced by the Ontario Hospital Association, the Ontario Association of Community Care Access Centres and the Ontario Federation of Community Mental Health and Addiction Programs.

An advance copy obtained by the Star notes that Ontario spends disproportionately more on physicians than other provinces. Last year, physician expenditure in Ontario was $842 per capita, compared with $675 per capita in other provinces. Ontario would save $2.2 billion annually if its spending on doctors was more in line with that of other provinces.

The report urges the province to take more of a “business-case approach” to allotting scarce health-care dollars. Funding decisions should be based on evidence that shows good return on investment and better quality of patient care.

The report calls on the province to amend the Public Hospitals Act and do away with hospital privileges for doctors, instead putting them on contracts that set out performance goals. Doctors would be reimbursed, for example, for seeing a specified number of patients in a certain time frame. Their pay would also be linked to patient outcomes.

Many physicians, including those who work in hospitals and have what is known as hospital privileges, get a large share of their remuneration from fee-for-service billings to OHIP.

The report states that about $800 million annually could be saved by better managing the care received by the 1 per cent of the population who account for a whopping 49 per cent of hospital and homecare costs. These tend to be very young and very old people who suffer from chronic conditions.

Other savings could be found by better managing chronic conditions, improving home care, increasing at-home palliative care and providing more community mental health and addiction services.

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