Monday, March 20, 2000 The National Post

Ontario, doctors resume pay-reform negotiations

By Colin Perkel
The Canadian Press

Primary care the focus: Report recommends family doctors form group practices Colin Perkel The Canadian Press Negotiations between Ontario's physicians and the Ontario government begin tomorrow as both sides attempt to strike a deal before the Legislature resumes sitting on April 3.

With the province now spending more than $20-billion a year on health care, about $5-billion of it on doctor billings, money remains a controversial issue.

At issue is the government's push for changes to the way front-line doctors are paid and interact with patients.

"Primary-care reform is not supported by the family physicians of this province," says Dr. Sharla Lichtman of the 3,000-member Coalition of Family Physicians.

"Primary-care reform is being pushed by the government as a way of removing responsibility for the health care crisis from their shoulders and putting it on the shoulders of family physicians."

The vast majority of Ontario's 24,000 doctors now operate under a fee-for-service model -- billing the Ontario Health Insurance Plan for each patient visit and each service provided.

For front-line doctors, it amounts to an OHIP bill of close to $2-billion a year.

But in a key report in November, the provincial Health Services Restructuring Commission recommended rapid changes that would see family doctors cluster into group practices and be paid by type of patient rather than for each service.

For example, doctors would earn more for the infants and elderly in their practice than for people in their 20s and 30s.

The new model, which relies heavily on support providers such as nurse practitioners, would save an unspecified amount of money, improve care, and ease congestion in hospital emergency wards, the report said.

Insiders say the government is willing to buy the change to physician payments with a bigger pay offer, although Mike Harris, the Premier, will not say how much bigger.

Adding to the pressure is a coalition of 11 mostly non-physician organizations that claim to speak for more than one million consumers.

The coalition, representing midwives, older Canadians, nurses and others, is pushing the government to implement quickly the commission's proposed changes to primary care as the "only way" Ontarians will have access to publicly funded quality services day and night.

They say "rostering" allows doctors to get off the fee-for-service treadmill that encourages them to churn through as many patients as they can and will mean better care.

But Dr. Lichtman is adamant that while the changes might help the government control costs, they will do nothing to solve the current health care crisis.

"Patients are dying in ambulances and emergency wards. Patients are dying waiting for surgery and treatment. Cancer patients are being uprooted from their families and being shipped to the United States.

"Primary-care reform does not address any of these problems."

Dr. Jan Kasperski of the 6,000-member Ontario College of Family Physicians, whose group generally supported the commission's suggestions, says it is crucial that doctors can choose how they practise and get paid.

That appears to be the approach of the Ontario Medical Association, which is trying to balance the competing interests of its members in the negotiations that began Jan. 18.

While the OMA will not say publicly what it wants, it has said it favours choice of payment options.

The last deal -- reached in 1997 after a five-week job slowdown by doctors -- was worth as much as $500-million and the premier suggested recently they will get at least as much this time.

But more recently, Mr. Harris warned against expecting pay hikes of anything more than 2% -- roughly the rate of inflation.