Social Policy in Ontario

Ontario is paying more per capita than other provinces for its doctors, and shaving 10 per cent off that difference would spell $220-million in savings, a new report suggests.

“Based on per capita calculations we spend $2.2-billion more on doctors in Ontario than they do in other provinces,” said Tom Closson, president and chief executive officer of the Ontario Hospital Association, which wrote the report with two other groups. “So we feel that it is an area that requires specific attention.”

Proper wound management, preventing medical errors and having better crisis care available to keep the mentally ill out of emergency wards are just a few ways the province could save millions, according to the report, also authored by the Ontario Association of Community Care Access Centres and the Ontario Federation of Community Mental Health and Addiction Programs.

But it is who earns what in health care that has become a contentious topic, with remuneration of hospital chief executive officers being an especially sore point. With the province’s health-care system consuming 42 cents out of every dollar in program spending – $43.5-billion budgeted for fiscal year 2009-2010 – doctors, as one of the biggest cost drivers of the system, are under the spotlight as well.

That includes greater scrutiny of fees paid to Ontario’s 24,000 physicians – one of the few groups paid by the government whose incomes, if they reach $100,000 or more, are not made public.

“You’ve got a population there that is utilizing a big chunk of the health-care pie expenditure,” said Margaret Mottershead, chief executive officer of the Ontario Association of Community Care Access Centres and a former deputy minister of health. “In comparison to other provinces, there doesn’t seem to be rhyme or reason because you’re not getting anything more.”

The report also suggests that doctors’ relationships with hospitals should change. Instead of having privileges granted to them, they should sign contracts, which would provide for greater accountability.

The suggestions didn’t go over well with the Ontario Medical Association. Its president, Suzanne Strasberg, called the figures misleading and said changing the reporting structure between physicians and hospitals would legally prevent doctors from advocating on behalf of their patients.

“While they produce maligning reports and make false allegations about physicians and others,” Dr. Strasberg said in a written statement, “Ontario’s doctors are working closely with hospital administrators, nurses, ministry officials and other partners in the health care sector to find innovative solutions to improve quality care to patients.”

But Ms. Mottershead said the report is merely trying to inspire greater accountability and identify savings.

“If you really want an accountable health-care system, you have to follow the same rules,” she said. “…You have to be transparent.”

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