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News Release
Social Contract Clawback
Magnifies Fee-for-Service Distortions
December 18, 1994
Ontario's doctors will find their pay cheques docked by six per
cent starting this month under a Social Contact provision negotiated
between the provincial government and the Ontario Medical Association.
The clawback, which the OMA has decided to apply on a straight
percentage basis rather than on a sliding scale based on income,
will penalize lower-billing physicians who typically take more time
with patients, says the Medical Reform Group, a physician group
critical of OMA policy.
"This will be demoralizing for the most conscientious physicians
who are already under considerable stress," said MRG spokesperson
Dr. Gordon Guyatt, "and therefore could potentially compromise
patient care."
Under the social contract, Ontario physicians are subject to a
"hard cap" of $3.654 billion in billings for the 1994-95
fiscal year, which ends March 31. Billings in excess of that amount
have to be paid back. So far, the cap has been exceeded by $219
million, an amount expected to rise to $240 million by the end of
the fiscal year. The current clawback will result in about $120
million being deducted, leaving another $120 million still owing.
According to the Medical Reform Group, the fee-for-service system
under which most physicians are paid encourages "revolving-door"
medicine. Doctors who practice high-volume medicine are the ones
who bear the greatest responsibility for the increase in billings,
but the clawback will be felt most severely by those at the lower
end of the income scale whose billings haven't increased and who
typically spend more time with patients, the MRG says.
"Instead of addressing the distortions caused by the fee-for-service
system, the OMA and the government are acting in a way that will
demoralize conscientious physicians while encouraging those who
practice revolving-door medicine to make their doors revolve even
faster," said Dr. Guyatt.
The Medical Reform Group believes that capitation and salary are
preferable to fee-for-service as a method of paying primary care
physicians.
The MRG also fears that the clawback will encourage more physicians
to resort to charging their patients so-called "administrative
fees" as a way of supplementing their income. "Administrative
fees are a form of extra-billing, which is clearly prohibited by
the Canada Health Act. The government should be acting to outlaw
these regressive fees, not to encourage them", said Dr. Guyatt.
Contact:
Dr. Gordon Guyatt
Dr. Rosana Pellizzari
Dr. Mimi Divinsky
Administrator: Ulli
Diemer
Medical Reform Group of Ontario
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