Now we know that 194 Ontario doctors have landed on the top 100 list of annual OHIP billers at least once since 2011.
Nearly half are ophthalmologists and radiologists. Just nine of the top-billing doctors are women. The billlings ranged from $1.4 million to $6.9 million a year.
Just to be able to know and publish those facts took a five-year legal battle by the Toronto Star to overcome the Ontario Medical Association’s attempts to keep this information under wraps.
It shouldn’t have taken anything like that. How much the provincial government pays doctors through the Ontario Health Insurance Plan should be public information. And not just for the top 100 doctors, but for all of them.
This isn’t a revolutionary idea. British Columbia, Manitoba and New Brunswick already make doctors’ billings public and the sky hasn’t fallen there.
Ontario’s annual Sunshine List has long disclosed the names and salaries of public employees who earn $100,000 a year or more. There was never a good reason for doctors to be exempt from a similar requirement regarding how much they receive from the province. Ontarians have a right to know how their health care dollars are spent.
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The courts have repeatedly ruled that the public’s right to know how substantial government funds are spent trumps the privacy concerns of doctors. The government pays $12.1 billion a year in physician compensation — roughly 8 per cent of the entire provincial budget — so that’s pretty substantial.
It’s important, of course, to remember that what doctors bill OHIP is not the same thing as their take-home salary. A good chunk of what they bill goes to pay staff and office costs.
How much? Well, we don’t know because the government doesn’t track that information. Some specialists certainly do have high overhead costs and the Eye Physicians and Surgeons of Ontario says it can be as much as 50 per cent of billings for some ophthalmologists.
Among the database of top billers there are a few doctors with histories of overbilling or professional misconduct as, no doubt, is the case with lower billers, too. The provincial government already has plenty of (still unfulfilled) recommendations from past auditor’s reports to improve its oversight mechanisms to reduce problem billings.
The public benefit that comes from greater transparency around OHIP billings is clear. It will help to inform the debate about how Ontario spends its health care dollars and whether the current payment structure overvalues some medical services at the expense of others.
Setting aside the top billers, the average ophthalmologist bills $724,000 a year while the average family doctor bills $307,000, according to the Canadian Institute for Health Information.
To be sure, doctors who have more years of training, higher overhead costs and work longer hours should be paid more. But the pay gaps have grown dramatically, fuelled in part by improved technology.
Fee-for-service proceduralists, such as ophthalmologists and radiologists, have benefited from advances that allow them to work faster and bill OHIP more. The more cognitive specialities such as pediatrics, geriatrics and psychiatry have not had similar benefits and are among the lowest paid.
Does a fee-for-service structure result in the best medical decisions when there’s clearly an inherent incentive to rack up the billable procedures?
Is the compensation system discouraging doctors from entering preventative and primary health care fields, which are more vital than ever given an aging population faced with chronic conditions and complex needs?
Those concerns have long been debated largely behind closed doors in the medical community and during contract negotiations with the province. Indeed, a group of high-paid specialists is currently pushing to break away from the Ontario Medical Association because of its ongoing, but incredibly glacial, attempts to restore some fairness to the compensation system.
Since health care dollars are finite and needs are growing across the board that, ultimately, involves taking a bit from the highest paid to give to the lowest paid.
Transparency around OHIP billing can help bring debate about the pay gap and what changes are needed into the public realm, where it belongs.
What do we value in health care? Are we achieving the best health care outcomes for the dollars we spend? Is there a better way?
The database of the top 100 that the Star was able to get through the courts should just be the beginning.
Two months ago, the Ministry of Health said it was in discussions with the Ontario Medical Association to make all doctor billings publicly available. That’s welcome news and the government should move ahead with that as quickly as possible.
Opening up the system to public scrutiny can only help to build a stronger health-care system for patients and doctors alike.
https://www.thestar.com/opinion/editorials/2019/06/27/transparency-on-what-doctors-bill-ohip-informs-the-health-care-debate.html
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