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Govind Rao

Tracking the grey zone in Quebec health care: critics decry extra fees | Montreal Gazette - 0 views

montrealgazette.com/...-care-critics-decry-extra-fees

from heather quebec user fees private clinics privatization

shared by Govind Rao on 24 Nov 15 - No Cached
  • November 15, 2015
  • November 15, 2015 |
  • When François Richard worried about an infection in his mouth, his doctor suggested he might have throat cancer. Richard said his physician outlined two choices: pay $250 up front for a quick test on the spot at the clinic or wait three months for a hospital appointment. Scared for his life, the Montrealer paid for the laboratory test immediately.
  • Govind Rao on 24 Nov 15
     
    Quebec's first public registry of extra billing for medical services reported that 527 patients were billed a total $40 775 between February and August this year. Fees included $600 for eye drops and $135 for an ultrasound, with family doctors charging an average of $63 in extra fees and consultants an average of $91.
Irene Jansen

Charging Patients for Services: Much Confusion, Little Consensus October 27 2011 - 0 views

www.healthydebate.ca/...block-fees

user fees primary care ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The Ontario Health Insurance Plan (OHIP) does not cover all health services that can be provided by a doctor. These “uninsured” services include telephone renewal of prescriptions, writing sick notes for work or school and transferring medical records.  Doctors can offer patients the option of paying for a set of uninsured services with a single “block fee.”   There is a lack of clarity about what a reasonable block fee is, how doctors communicate the existence of the fee to patients, and patients’ options regarding the block fee.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Govind Rao

User fees threatened for patients across Canada if court challenge negotiations fail to... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wcnw|20140929|205044899

from heather private clinics privatization ontario bc court coalition

shared by Govind Rao on 29 Sep 14 - No Cached
  • Canada Newswire Mon Sep 29 2014
  • TORONTO, Sept. 29, 2014 /CNW/ - As Ontario's new Health Minister Dr. Eric Hoskins sits down with provincial and territorial Health Ministers for their fall meeting this week, experts and patient advocates hope that he'll carry a strong message. Across Canada advocates are calling on the B.C. Health Minister to hang tough on the Medicare court challenge which threatens open season on patient user fees for surgeries, diagnostics and other procedures. The case was scheduled to begin on September 8, but lawyers for both Brian Day, owner of one of the largest private clinics in Canada, and the B.C. government asked the court for a delay in order to negotiate a settlement. Negotiations are now happening behind closed doors and the court date is delayed until March 2015.
  • Following a provincial audit in 2012 which revealed that Day was charging hundreds of thousands of dollars in unlawful user fees to patients, Day filed a Charter Challenge to nullify the laws that he was violating. His case aims to bring down the laws that protect single-tier Medicare and forbid clinics like his from extra-billing patients and charging user fees for care that currently must be provided without charge under the public health care system. The litigation has far-reaching implications for the entire country. Day's clinics were first exposed by patients who complained they were unlawfully billed for medical procedures. The B.C. government responded by trying to audit the clinics. Day refused to let in auditors until forced by a court order, and even then the clinics did not fully comply with auditors. Auditors had access to only a portion of the clinics' billings and only one month's worth of data. Nevertheless, what they found was astonishing. In a period of about 30 days, patients were subject to almost half a million dollars in user charges. The five patients who brought the initial legal petition have had their trial delayed while Day's Charter Challenge to the laws upholding single-tier Medicare is heard. They are still waiting for redress.
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  • "In order to protect patients, the B.C. government must hold private clinic owners and operators accountable when they break the laws prohibiting extra-billing and user fees," said lawyer Steven Shrybman, a partner at Sack Goldblatt Mitchell who is acting for the B.C. Health Coalition and Canadian Doctors for Medicare, intervenors in the court challenge. Shrybman is well-known for his successful Supreme Court challenge against Ontario's attempted sale of Hydro One and the recent election fraud cases in Federal Court. "Though the challenge was launched in British Columbia, it has the potential to bring two-tier care to Canadians across the country," he warned. "Advocates of public health care from Ontario and across the country are calling on the B.C. government to take a tough stand in these negotiations. These are the laws that uphold Medicare and defend patients," said Dr. Ryan Meili, Vice-Chair of Canadian Doctors for Medicare. "A simple slap on the wrist encourages more violations in provinces from coast to coast."
  • The problem is already creeping into Ontario, according to Natalie Mehra, executive director of the Ontario Health Coalition, where the government is proposing to expand private clinics. "Patients are being confused by private clinic operators who are manipulating them into paying thousands of dollars for health care services that they have already paid for in their taxes," she warned. "The public should know that you cannot be charged by a doctor or private clinic operator for surgery, diagnostic tests or any other medically necessary hospital or physician service. Extra user fees charged to sick and elderly patients are unlawful and immoral and governments should be delivering that message." Advocates warned that this court case should also raise alarm bells in Ontario's government about the dangers of private clinics. At risk is our public health system in which access to health care is based on need, not wealth. SOURCE Ontario Health Coalition
Govind Rao

NDP says ambulance fees need to be capped - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|sasp|20150305|215749106

from heather Saskatchewan ems user fees

shared by Govind Rao on 05 Mar 15 - No Cached
  • The StarPhoenix (Saskatoon) Thu Mar 5 2015
  • A Saskatchewan man who says he was hit with ambulance bills worth more than $5,000 after his wife's death wants the province to change its policies. Dave Carr, 70, said his wife had cervical cancer and her illness required six ambulance trips before she died in October 2013. "I went through hell," he said. "I covered every possible avenue to try to get some help." The NDP Opposition raised Carr's case in the legislature Wednesday as an example of a "broken" ambulance fee system.
  • Health Minister Dustin Duncan said ambulance fees are heavily subsidized in Saskatchewan and 71 per cent of the cost is borne by taxpayers. An ambulance pickup costs $245 or $325 plus $2.30 per kilometre. "Free health care isn't free," Duncan said. "We pay over $5 billion in this province just through the public purse in terms of what we cover for health care."
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  • NDP Leader Cam Broten said Saskatchewan has one of the worst records for ambulance fees in the country. He said it's the only province to charge for ambulance transfers between hospitals and it's one of two provinces, along with Quebec, that doesn't have a capped rate. Carr said his wife Catherine, who was 62, was not eligible for the seniors rate of $275 a trip. "I'm fighting because it's just wrong, period," he said.
  • Ambulance rates vary across Canada. In New Brunswick, patients without private insurance are eligible for free services; in Ontario, patients are charged $45 for medically necessary trips within the province; in Manitoba, fees depend on the area, but in Winnipeg, basic service is capped at $512. Sara Bucsis-Gunn said she wasn't prepared for the more than $7,000 in bills she received for her daughter's trips to hospital in Saskatchewan.
  • Leandra, who was seven years old when she died in April 2013, required emergency ambulance trips because of seizures related to a congenital medical condition. She also needed transfers between a hospital in Regina, where her family lived, and a Saskatoon facility. Bucsis-Gunn said she felt abandoned by the health care system.
  • "That's why I'm so angry with our government ... all of her pain and suffering and extra stress that was put onto our family when we were already at our maximum capacity, all of that was in vain," she said. Bucsis-Gunn said her daughter went home on palliative care at birth, but survived against the odds. "And the treatment she got for surviving was horrid," she said.
  • As ambulance bills piled up, the family struggled to pay for necessities such as a wheelchair, she added. Bucsis-Gunn said the financial stress pushed her to forgo ambulance rides whenever possible. After a hip reconstruction surgery, she transported Leandra home on a blow-up mattress in the back of a van. "She was a trooper," Bucsis-Gunn said, crying. "She had this infectious laugh ... she just loved to be loved, that's all she cared about."
  • Bucsis-Gunn, 29, said she doesn't want other families to go through the same thing. "You feel so much pressure to just do the right thing for your child," she said. "But at the same time, to do the right thing financially cripples your family."
  • David Carr's wife Catherine had stage-four cervical cancer. and required six ambulance trips before she died.
Govind Rao

Proposed User Fees for Health Services in Quebec Threaten Canadian Health Car... - 0 views

www.huffingtonpost.ca/...ser-fees-quebec_b_8305986.html

from heather quebec user fees legislation privatization private clinics

shared by Govind Rao on 21 Oct 15 - No Cached
  • 10/21/2015
  • With the recent federal election grabbing the majority of the headlines, a significant threat to Canada's most treasured national program has been going largely unnoticed. For many years, certain physicians and clinics have quietly been charging extra fees for health services. In some provinces, the frequency of such charges has been increasing. These include hidden charges for medications that are many times their actual cost or access fees of hundreds of dollars for examinations such as colonoscopies. Because these fees are for services that are covered by the health system, this is in effect extra-billing, a practice that is against federal and provincial law
Heather Farrow

The murky waters of Quebec extra-billing - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20160920|256519337

Quebec fees privatization private clinics

shared by Heather Farrow on 20 Sep 16 - No Cached
  • The Globe and Mail Tue Sep 20 2016
  • The government of Quebec is taking the eminently sensible - and legally mandated - step of abolishing extra-billing for publicly insured medical services. Good news! But there's a problem: the changes won't take effect until early next year, and nobody really knows how much in extraneous fees is being charged in the province. How is that possible? Overbilling has been a hot-button issue for the better part of four decades. Depending on whom you talk to, Quebec's doctors are charging patients $50-million to $90-million a year in added fees.
  • Earlier this year, the provincial auditor-general said the Quebec government's own estimates ($83-million) don't seem to be based in verifiable fact. One Montreal-based lawyer is suing the province over extra fees. He says Quebec is Canada's worst offender; he may be right, but who really knows? The Canada Health Act forbids extra-billing, but successive federal governments have mostly treated it with impunity. At least Dr. Gaetan Barrette opted to ban fees outright rather than apply his initial prescription - to pay practitioners an equivalent additional amount out of provincial coffers. Two years ago, he leaped into politics, and has brought about a series of deep reforms. (His many critics think he's a bully and a demagogue.) Probably his hand has been forced by ongoing litigation and federal Health Minister Jane Philpott.
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  • Reportedly, Dr. Philpott wrote to her counterpart earlier this month, intimating Ottawa would start withholding transfer payments if extra-billing is not addressed. Now Dr. Barrette is making the typical spluttering noises about Ottawa invading provincial jurisdiction and claiming credit. In recent years, the provinces have tended to treat the federal Health Department as a cash machine; the extra-billing skirmish may end up being part of a broader negotiation over a likely reduction in federal transfers.
  • Let's hope Quebec's decision, and Dr. Philpott's role in it, signal a new era of robust federal defence of publicly funded medicare. With the British Columbia Supreme Court hearing arguments this week in a case that challenges some key pillars of the Canada Health Act, such robustness is needed.
Irene Jansen

Surgeon is leaving MUHC to work at own clinic - 0 views

www.canada.com/...story.html

quebec private clinics cha user fees investigation

shared by Irene Jansen on 03 Apr 12 - No Cached
  • The McGill University Health Centre has ended its relationship with a private bariatric surgeon
  • The McGill University Health Centre has ended its relationship with a private bariatric surgeon
  • MUHC had launched an internal investigation after patients alleged a prominent bariatric surgeon at the hospital had accepted money in return for fast-track access to medically necessary weight-loss surgery
  • ...7 more annotations...
  • Christou said he asked some patients to pay his surgical fees at the Royal Victoria once he had opted out of medicare.
  • He said he has had enough of working in the public system, which is poorly funded, and would rather devote himself to a few patients in private practice.
  • "We realized that maybe it's not appropriate for a doctor who has opted out of RAMQ to continue to be part of the MUHC,"
  • "I am perfectly within my legal rights as a non-participating physician to charge my surgical fees even if I do my surgery within a public institution
  • And charge whatever surgical fees within the code of deontology (of the physician's board) - you can't ask for a million dollars - but you can ask for whatever the market will bear as long as you are completely non-participating physician," Christou said.
  • RAMQ, the Quebec health insurance board disagrees. It says patients can't be charged for medically necessary treatments, which are covered by medicare, whether these are performed in public or private institutions.
  • The insurance board recently reimbursed eight patients $73,000 for improper user fees charged at a private clinic, Rockland MD surgical centre, and has investigations pending at several other private clinics.
Irene Jansen

Adami: A need for affordable care - 4 views

www.canada.com/...story.html

assisted_living ontario fees

shared by Irene Jansen on 28 Jun 12 - No Cached
  • Carolyn Daniels says a revised fee system for special-care services imposed by the operator of an Ottawa retirement home will force her mother out of her room.
  • additional costs of $1,793 a month
  • At Westwood, Revera includes a long-term care component. The care is similar to what it offers in its nursing homes.
  • ...10 more annotations...
  • owned by Revera, which operates retirement homes and nursing homes throughout Canada and the United States
  • Revera says it is introducing an “à la carte” service for all residents in its Ontario retirement homes to cover its costs.
  • Those services have been costing $478 a month on top of the $2,774 she pays for accommodation and food. The same care services will rise to $2,271 in September for a total monthly charge of $5,045.
  • Daniels’ relationship with the home soured about a month ago, when she found out her mother was going to be hit with new fees for services such as continence toileting or being escorted to the dining room.
  • Daniels says her mother is receiving all those services now for about one-fifth of the price. “It just boggles the mind,” she says.
  • The new fees don’t apply to Revera’s Ontario nursing homes because monthly rates for such facilities are determined by the provincial health ministry. But the ministry does not regulate fees for retirement homes or their long-term care components, so Provost and others living on Westwood’s two long-term floors are sitting ducks.
  • Bernard Bouchard, executive director of the Council on Aging of Ottawa, says he believes Revera is trying to make up some of its extra costs from new licensing regulations brought in by the Ontario government in April 2011. As well, he says, operators are trying to find new revenues as retirement homes are operating at about 80-per-cent capacity.
  • Daniels says her mother will have to move to a nursing home. And there lies another problem. She will have to go on a waiting list because nursing homes are full.
  • having a staff member escort her mother, who uses a walker, to the dining area and back to her room three times a day will cost $606 a month. Helping feed her when she needs assistance is another $252. Checking her room twice nightly, to see if she has fallen out of bed or needs to go to the washroom is $168. Continence toileting is $673.70. She will also be charged an additional $505 monthly for general staff assistance.
  • they said: ‘We can look after her, we have palliative care. She can stay here until she dies.’ ”
Irene Jansen

CHSRF - The Use of Health Technology Assessment to Inform the Value of Provider Fees: ... - 0 views

www.chsrf.ca/...35-4d4b-96c3-b3af4050d0e4.aspx

funding technology doctors fee for service vfm

shared by Irene Jansen on 23 Jan 12 - No Cached
  • CHSRF Series of reports on cost drivers and health system efficiency: Paper 6
  • Currently, provider fees are largely based on the costs to deliver the service, not the relative value-for-money of the new service. This approach means providers may have little to no incentive to perform high-value services compared to low-value services.
  • Health technology assessment (HTA) examines the medical, economic, social and ethical implications of the use of medical technologies, services and procedures. Because it has the capacity to capture value, HTA is considered an effective tool in making policy decisions to develop professional fees in response to the availability of new health technologies. In theory, using HTA to inform the price of a provider fee can lead to reductions in net expenditures while increasing payments to providers.
  • ...1 more annotation...
  • Canada would benefit from a coordinated approach to price determination.
Irene Jansen

Clinics' user fees facing crackdown in Quebec - 1 views

www.montrealgazette.com/...story.html

private clinics qc user fees doctors cha

shared by Irene Jansen on 06 Mar 12 - No Cached
  • Quebec's medicare board is now taking an aggressive approach in cracking down on private clinics that charge patients illegal user fees.
  • Among the services charged to patients are "nursing accompaniment" during an operation, "teaching services" and a post-operative follow-up phone call.
  • RAMQ is seeking at least $73,000 in fees that Rockland MD charged patients, based on the findings of eight patients
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  • Dr. Fernand Taras, medical director of Rockland MD and the majority shareholder
  • When informed the law does not allow doctors taking part in the public system to bill patients for nursing care, Taras grew increasingly agitated, shouting at the reporter over the phone, saying: "I will sue your guts."
  • Quebec also changed the law governing RAMQ to permit it to launch investigations on its own initiative - rather than act on complaints by patients - following a Gazette exposé on private health care in 2005.
Govind Rao

Andy Harvey, Liberal MLA, defends changes to nursing home fees - New Brunswick - CBC News - 0 views

www.cbc.ca/...to-nursing-home-fees-1.3064663

from heather NB ltc user fees

shared by Govind Rao on 08 May 15 - No Cached
  • Seniors' advocacy group says New Brunswick rates are already the highest in Canada
  • May 07, 2015
  • Liberal MLA Andy Harvey explained the provincial government's changes for nursing home fees in front of a crowd of about 150 people in Woodstock on Thursday evening. (Redmond Shannon/CBC)
  • ...1 more annotation...
  • A crowd of more than 150 Woodstock-area residents attended a public presentation about the provincial government's new rules on nursing home fees. Cecile Cassista, the executive director of the Coalition for Seniors' and Nursing Home Residents' Rights, organized the event.
Govind Rao

Quebec Doctors for Medicare concerned about private clinic fees - CBC News - Latest Can... - 0 views

www.cbc.ca/...-private-clinic-fees-1.3131576

from heather Quebec doctors fees private clinics privatization

shared by Govind Rao on 29 Jun 15 - No Cached
  • Jun 29, 2015
  • Quebec Doctors for Medicare concerned about private clinic fees
  • Doctors say Bill 20 would result in more Quebecers paying private-clinic fees.`
Govind Rao

Ambulance fees a roadblock for many who need care - Health - CBC News - 0 views

www.cbc.ca/...r-many-who-need-care-1.2946576

from heather ems user fees

shared by Govind Rao on 06 Feb 15 - No Cached
  • Marketplace finds many Canadians would delay calling an ambulance because of cost
  • Feb 06, 2015
  • Some Canadians don't call an ambulance when they need one because they are worried about paying the fee, an investigation by CBC's Marketplace reveals. And the life-saving service has left others with thousands of dollars in bills they can't afford. Ambulance fees range from $45 in Ontario to more than $500 in parts of Manitoba. In Saskatchewan and Newfoundland and Labrador, you could also be charged for being transferred by ambulance from one facility to another.
Govind Rao

Paying to be a patient? Toronto woman calls doctor's annual $150 fee request 'galling' ... - 0 views

www.ontariohealthcoalition.ca/...annual-150-fee-request-galling

from heather user fees doctors primary care Ontario

shared by Govind Rao on 15 Dec 15 - No Cached
  • December 10, 2015
  • A Toronto woman is upset with a letter she received from her doctor asking for an annual fee. Such practices are allowed but she feels the missive wasn’t clear it was for optional services.
  • These sorts of “block fee” requests are increasingly normal in Ontario and permitted under the law, so long as they cover things such as doctor’s notes and insurance forms not covered by the Ontario Health Insurance Program.
Govind Rao

Alberta plans change in doctor compensation - 0 views

www.cmaj.ca/E101

from heather Alberta doctors wages

shared by Govind Rao on 04 Apr 16 - No Cached
  • CMAJ April 5, 2016 vol. 188 no. 6 First published March 7, 2016, doi: 10.1503/cmaj.109-5240
  • Zoe Chong
  • Alberta plans to change how doctors are paid in a bid to curb spiraling costs and improve quality of care.
  • ...13 more annotations...
  • The current model for paying physicians is “expensive, outdated and doesn’t support the efforts of doctors to provide the best care possible,” said Health Minister Sarah Hoffman at a Feb. 8 policy forum in Edmonton on the health system’s fiscal sustainability.
  • In 2014, Alberta spent $1060 per capita on physician services — the third highest in the country. More than 80% of payments are through fee-for-service, where doctors bill the government for each medical service provided. Proponents of fee-for-service say it gives doctors the incentive to see as many patients and provide as many services as possible. Hoffman wants some of the doctors on fee-for-service to adopt Alternative Relationship Plans (ARP), which she said are not only less expensive, but also reward doctors for the quality of care they provide.
  • Under clinical ARPs, doctors are paid for providing a set of services at a facility to a target population. There are several types. The annualized ARP, the most common in Alberta, provides compensation based on a formula that determines the number of full-time equivalents (hours per year or days per year) required to deliver services.
  • In Ontario, the most common ARP is the capitation model, under which physicians are paid a fixed fee per month for each patient registered with their practices, regardless of services received.
  • The Alberta Medical Association (AMA), which represents the province’s 8921 licensed physicians, supports the change. President Dr. Carl Nohr told CMAJ that ARPs are part of the move toward modernizing the health care system, which now deals with more chronic illness. They give doctors more flexibility, he said.
  • “They’ll be able to vary the amount of time they spend with individual patients, define how frequently they see patients — all in the context of what’s good for the patients and not necessarily from the business perspective.”
  • Neither the AMA nor Hoffman could specify the number of doctors they want to adopt this model. Nohr said compensation under an ARP will remain optional, but “our goal is to make it as attractive as possible and make changes to the model as we go, and hopefully over time see a substantial uptake.”
  • Alberta’s total health budget is $19.7 billion for 2015–16 — the second highest per capita ($4800) among the provinces. But, Hoffman said, “Given how much money is spent on health care in Alberta, the health outcomes in our province can and should be better.”
  • Hoffman said health care accounts for 45% of the government’s overall budget, and continues to grow faster than both inflation and the population, which grew 2.17% in 2015. If health care spending continues to rise by an average of 6% annually, it will account for 60% of the province’s budget in 20 years. Hoffman wants to decrease growth in health care spending to 2% annually in the next few years, but stressed this does not mean cutting funding; it means curbing spending growth.
  • Hoffman doesn’t know how much will be saved by changing the physician compensation system, but said “changing the way we pay doctors will have a ripple effect on the entire health system.”
  • The government’s contract with t
  • e AMA expires in 2018, and both parties are discussing redirecting funds and developing alternative compensation models. Nohr said they’re looking into a blend of ARP and fee-for-service among primary-care physicians.
  • One of the very good things that gives me hope for the future is that the profession and the government have a very good relationship,” Nohr said. “So there’s a collaborative, positive relationship between the Alberta Medical Association and the Ministry of Health and that creates the possibility for productive, useful change.”
Irene Jansen

Robert Evans on doctor shortage Healthcare Policy Vol. 7 No. 2 :: Longwoods.com - 3 views

www.longwoods.com/22659

doctors hhr ally excellent

shared by Irene Jansen on 06 Sep 12 - No Cached
  • And second, a lid must be placed on APP program payments. Funding for benefit and incentive programs should be folded into the negotiation of fee schedules, recognizing that they are, like fees, simply part of the average prices physicians receive for their services.
    • Irene Jansen
      Irene Jansen on 06 Sep 12
       
      Alternative payments program (app) is the term used to describe the funding of physician services through means other than the fee-for-service method.
  • the coming increases in numbers have, once again, foreclosed for decades the possibilities for exploiting the full competence of complementary and substitute health personnel, expanding interprofessional team practice and in general, shifting the mix
  • Including rapid growth in net immigration, the annual "crop" has nearly doubled.
  • ...16 more annotations...
  • Canadian medical schools have expanded their annual enrolment by 80% over the last 13 years
  • it is politically extremely difficult, almost impossible, to cut back on medical school places once they have been opened.2
  • In the last decade, medical expenditure per physician has also risen, by nearly 35% above general inflation.
  • Each of these waves of expansion responded to widespread perceptions of a looming "physician shortage." How accurate were those perceptions? In the case of the first wave, they rested on assumptions that were simply wrong, and by a wide margin. Medical schools were built to serve people who never arrived.
  • major increase in physician supply per capita, from 1970 to 1990, did not result in underemployed physicians. Utilization of physicians' services adapted to the increased supply. Whether the additional physicians were "needed," and what impact their activities might have had on the health of Canadians, are good and debatable questions
  • Does all this increased diagnostic activity among the very elderly actually generate health benefits?
  • As in the case of the previous major expansion, the impact on the total supply of physicians will unfold slowly, but relentlessly, over decades.
  • Table 1. Canadian health spending, percentage increase per capita, inflation-adjusted   1999–2004 2004–2009 1999–2009 Hospitals 19.1 11.7 33.0 Physicians 16.4 24.4 44.8 Rx drugs 46.1 19.0 73.7 Total health 22.2 16.5 42.3 Provincial governments 21.2 17.7 42.6  
  • Over the nine-year period, there were very large increases in the per capita volume of diagnostic services – imaging and laboratory tests. Adjusting for fee changes, per capita expenditures on these rose by 28.4% and 42.1%, respectively.
  • much greater among the older age groups – 59.4% and 64.4%, respectively, for those over 75
  • money has been poured into reimbursing diagnostic services for the elderly and very elderly, but access to primary care for the non-elderly appears to have been constrained
  • insofar as more recently trained physicians tend to be more reliant on the ever-expanding arsenal of diagnostic technology, overall expenditures per physician will continue to rise as their numbers grow
  • (Population has grown by about 14%.)
  • a lot of money is going out the door and no one has a clear picture of what it is buying
  • The question of Canadian physician supply is now moot. The new doctors are on their way, and whether or not we will need them all is no longer relevant. It may be that as cost containment efforts begin to bite we will again see renewed limits on the inflow of foreign-trained physicians, but we will not be able to turn down the domestic taps as supply increases.
  • Growth in diagnostic testing has to be brought under control, both in how ordering decisions are made and in how tests are paid for.
Irene Jansen

Ontario needs to do its health-care homework - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2261360

capitation doctors ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • report delivered Monday by Auditor-General Jim McCarter
  • Since 2005, Ontario has made a concerted effort to shift doctors from fee-for-service to “capitation,” which sees them paid an annual fee for each patient.
  • Doctors are paid for patients who are “enrolled” with them, even if those patients don’t make any visits – so by the auditor’s calculation, they received $123-million in 2009-10 for treating people they never actually saw. Meanwhile, there appears to be leeway and incentive for doctors to de-enlist patients with medical conditions that require frequent visits, then shift them back to the fee-for-service model.
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  • doctors are reportedly earning 25 per cent more under capitation than they were under fee-for-service
  • total annual funding to family physicians went up by 32 per cent between 2006-07 and 2009-10
  • The path out of a $16-billion deficit, more or less endorsed by all three provincial parties in the recent election, revolves largely around flattening health spending increases
Govind Rao

Cathy Rogers unveils new nursing home fee formula - New Brunswick - CBC News - 0 views

www.cbc.ca/...ing-home-fee-formula-1.3059985

from heather ltc NB costs

shared by Govind Rao on 04 May 15 - No Cached
  • Social Development minister says many seniors will see their contributions drop
  • May 04, 2015
  • Some New Brunswick seniors will be facing substantially increased fees for nursing home care, but not as substantial as first announced, and not right away for some, Social Development Minister Cathy Rogers revealed at a news conference Monday morning.
  • ...2 more annotations...
  • Rogers says the provincial government is establishing a new cap on nursing home fees of $175 per day.
  • It's a 55 per cent increase over the current cap of $113 and will raise the annual maximum cost of staying in a nursing home to nearly $64,000, for those the government deems can afford to pay.
Govind Rao

Opponents decry 'asset grab' after unveiling of N.B. nursing home fee plan | CTV Atlant... - 0 views

atlantic.ctvnews.ca/ursing-home-fee-plan-1.2360262

from heather NB ltc user fees privatization

shared by Govind Rao on 06 May 15 - No Cached
  • Tuesday, May 5, 2015
  • The Gallant Liberals on Tuesday responded to criticism of their nursing home fee plan with a surprise announcement in the New Brunswick legislature. Social Development Minister Cathy Rogers announced details of the plan earlier than expected, saying the government prioritized finalizing the plan in response to the message other parties have been spreading. “We’ve not been happy with the fear mongering going on and seniors being afraid of the worst-case scenario, so we have prioritized,” Rogers said.
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