Social Policy in Ontario

Doctors’ billings: Transparency is the best medicine

Posted on June 9, 2016 in Health Debates

—

TheGlobeandMail.com – Opinion
Jun. 07, 2016.   ANDRÉ PICARD

Ontario’s privacy watchdog has ordered the province to publish the names of the 100 doctors whose billings to the Ontario Health Insurance Plan are highest.

An adjudicator, ruling on an access-to-information request from the Toronto Star, said the billings are “not personal information” and, even if they were, it would be in the public interest to reveal them.

The Ontario Medical Association, which represents the province’s 28,000 physicians, opposed release of the data, saying it could be misconstrued. (Billings are not salaries but gross payments from which doctors must pay office overhead, benefits and pension.)

The OMA has not yet decided if it will appeal the ruling. If it does not, the data will be made public on July 8.

The decision by the Office of the Information and Privacy Commissioner comes at a time when Ontario doctors are feeling put-upon (two years without a contract and repeated, unilateral fee cuts will do that), so it may inflame passions. But it also raises a number of important policy issues.

Government should be accountable for how public dollars are spent so openness and transparency are a must. Currently, Ontario publishes a “sunshine list” of the names of individuals on the public payroll with salaries in excess of $100,000. There were 115,431 people on the list last year. In principle, such disclosure should identify excessive salaries and outliers with the goal of accountability. But when you consider, for example, that 80 per cent of uniformed police officers now earn in excess off $100,000, that cutoff seems low.

Also, raw numbers – whether salaries or billings – don’t tell us if the public is getting value for money, which is what we really need to know.

We can’t ignore that there is prurience (economic, not sexual) at work here – a desire to expose public sector employees based on the notion they should earn considerably less than those in the private sector.

For example, the pay package of the province’s top health-care executive, Mount Sinai Hospital president Joseph Mapa, at $761,556.83, generates more headlines than the obscene earnings of Valeant Pharmaceuticals CEO Michael Pearson, $182.9-million. But back to doctors: Those who are salaried – and there are many – are on the sunshine list. Those who receive fee-for-service payments are not, and they shouldn’t be, because it’s apples and oranges.

But that doesn’t mean that, because they are contractors, their compensation should be kept secret. There is a long-overdue trend toward open contracting – and for good reason. Some of the greatest abuses of public spending occur in the awarding of contracts; in Quebec, it was oftentimes a thinly veiled criminal enterprise, as revealed by the Charbonneau Commission. When Ontario signs a contract with its doctors (and, to repeat, they have been without a contract for two years), the public should know how much doctors are paid from the public purse, individually as well as collectively.

This has been the norm in some other provinces for a long time – B.C. has published its Blue Book of physician billings since 1971 and Manitoba has done the same since 1996. (Prince Edward Island has also tabled legislation to disclose payments to all health-care professionals.)

U.S. Medicare (the public insurance program for everyone over 65) also publishes details of its $77-billion in annual billings by 88,000 providers, and with far more detail than any Canadian province. A searchable database allows the public to get billings by name, location, as well as information on services provided and payments per service. There is no reason that level of details should not be public in Canada.

Transparency is not an attack on doctors, nor a shaming exercise: It would reveal not only the high billers, but the low billers. (One unintended consequence of the Sunshine Act is that executives use it as a bargaining tool. Lower-paid doctors could, too.) The notion that the public might confuse billings with salary is a red herring. People are not stupid.

And, if there is a real concern that the information in inadequate, then physicians are free to publish their overhead costs – data that we already have by specialty (overhead of 12.5 per cent for ER docs to 42.5 per cent for ophthalmologists), but not for individual practitioners.

The solution to the eternal “how much are doctors really paid?” question is not secrecy or opaqueness, it’s more transparency.

< http://www.theglobeandmail.com/opinion/doctors-billings-transparency-is-the-best-medicine/article30304223/ >

Tags: budget, economy, Health, ideology, mental Health, rights, standard of living

This entry was posted on Thursday, June 9th, 2016 at 12:33 pm and is filed under Health Debates. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.