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Calgary Herald October 19,
1998.
Doctors
test run radical pay system
The Canadian press - Toronto
Doctors testing a new system
of family medicine and Ontario will be paid as little as $70.29
a year to treat some patients 24 hours a day, seven days a
week.
But in (sic) another twist,
there will be annual cash bonuses of up to $8,800 for doctors
who encourage patients to get Flu vaccines, Pap smear's, mammographies,
and childhood immunisation shots.
And doctors will get $100 an
hour to go back to school and almost as much to take part
in consultations with other physicians.
Already, the compensation package
detailed in a draft arrangement document is being criticised
by an organization that represents about one-third of the
province's family doctors.
And it's creating confusion
among patients who fear if doctors are paid as little as $70.29
a year to care for them, it will place limits on services.
"It's an insult to
the people of Ontario to have the government state that their
life is worth as little as $70.29 for a year," says Dr.
Sharla Lichtman, a spokeswoman for the 3,000-member Coalition
of Family Physicians of Ontario.
Some doctors say a new payment
structure which goes hand in hand with the government's primary-care
reform devalues patients, while also digging into pockets.
Under one compensation proposal,
doctors would be paid as set amount for patients depending
on how much care they are likely to require.
For example, a doctor would
be paid an average (correction: a maximum) of $70.29 a year
for every young male patient between the ages of 25 and 35.
Men in that age group tend to make few trips to the doctor.
However, and elderly woman
between 85 and 89 who may suffer from the diabetes, Parkinson's
disease and be at risk of contracting pneumonia will require
more care. Her agreement to sign on with a particular doctor
would be worth about $331 a year to that position.
[The new system that] will
dramatically alter the relationship between patients and family
doctors, will be tested in four Ontario communities starting
in January.
Similar tests are underway
in B.C., Alberta and New Brunswick.
Ron Kustra, of the Alberta
Medical Association, said a plan involving fees for comprehensive
care was developed several years ago.
"It's something that we've
promoted as a profession but it did does take two or three
parties to move ahead on," said Kustra. "So far
the only place where he it's moved ahead is Bassano, just
outside of Calgary, where the regional health authorities
and the 2 family doctors there got together and moved ahead
under this mode of delivering care were it's no longer on
fee for service per se.
"It's certainly something
we're quite prepared to encourage physicians who want to move
in that way to move ahead."
Under the new Ontario rules,
patients will be asked to sign contracts tying them to a particular
physician. Patients will have 24-hour care and their use of
the health system will be tracked through computers which
will give the doctors immediate access to their pharmacy and
hospital records.
The government says the new
system will allow it to spend shrinking resources where they
are most needed.
But Lichtman says doctors in
family practice stand to lose income and faced new costs.
Under the governments proposal, for example, doctors will
be required to pay up to $350 a month toward the new technology.
Quick
Facts
Details of new system:
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Cash
Bonuses: Based on percentage of patients a doctor
tends dear to ward preventive medicine. A doctor who vaccinates
60 percent of patients 65 and over would be paid a $220
bonus for that year. If 80 percent of patients are vaccinated,
the doctor gets $2, 220. There's a similar bonus scheme
for Pap smears, mammographies and childhood immunisation.
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Patient
Bounties: Doctors would be paid and annual fee for
each of their patients based on the age and sex of that
person. A child under four is worth $175.44 a year to
a doctor. A teenager 15 to 19 is worth $73.85. A man aged
35 to 39 is worth $105.41 while a woman of the same age
is worth $165.31. A man age 50 to 54 is worth $136.16,
while a woman of the same age is worth $189.26. A man
aged 85 to 89 is worth $340.87, while his female equivalent
is worth $331.06. |
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Education:
Doctors would be paid $100 an hour to take courses approved
by the Health Ministry. |
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Consultation:
A team of the doctors would be paid $47.35 for each half-hour
they spend consulting on the case. |
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