TORONTO, Oct. 23, 2013 /CNW/ - Specialist physicians should be paid by
the hospitals where they carry out their procedures, rather than by
provincial insurance plans as they are now, according to a report
released today by the C.D. Howe Institute. In "Paying Hospital-Based
Doctors: Fee for Whose Service?" authors Ake Blomqvist and Colin Busby
argue hospitals could then manage their personnel and resource needs
more efficiently, reducing waiting lists and costs.
"Most hospital-based specialist doctors are paid via fee-for-service by
provincial insurance plans, but most hospital funding comes through a
separate pipe, in the form of lump-sum amounts not linked to the
services provided," noted Ake Blomqvist. "The result is a system in
which neither specialists' time nor hospital resources are efficiently
used, contributing to high costs and long waiting lists."
Nationwide, more than 80 percent of surgical specialists' income comes
from fee-for-service payments that are negotiated collectively with
provincial health ministries, note the authors. Surgical specialists
make up about 20 percent of all full-time equivalent physicians, and
fee-for-service payments to them accounted for close to $4 billion
nationwide in 2011/12.
"Because physicians' decisions are major drivers for most healthcare
costs, getting the incentives right is critical to ensuring Canadians
receive good value for money," said Colin Busby.
One contributing factor to waiting lists, and one reason why many
recently graduated specialists in Canada are unemployed or
underemployed, is a lack of complementary facilities, such as operating
rooms, and the lack of complementary professionals, such as
anaesthesiologists, nurses and so on.
"When a medical procedure requires hospital facilities as well as
specialist time, the fee should be shared between hospitals and
specialists in ways that give both a stake in producing high-quality
care at low costs," said Blomqvist.
The authors propose that hospital-based physicians be paid directly from
hospital budgets. Hospitals would then engage doctors and pay them
appropriately - either by salary, fee-for-service, or a blend of
Alternatively, specialist physicians could become the conduit for a part
of government's funding of hospitals, and be required to pay hospitals
when using their facilities. This could appeal to specialists who want
to remain independent, and also promote competition among hospitals,
and between hospitals and independent clinics, in providing
For the report go to: http://www.cdhowe.org/paying-hospital-based-doctors-fee-for-whose-service/23271
SOURCE: C.D. Howe Institute
For further information:
contact: Ake (pronounced "Okie") Blomqvist, Health Policy Scholar, or Colin Busby, Senior Policy Analyst, C.D. Howe Institute, 416-865-1904; email: firstname.lastname@example.org