Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, January 31, 2010

Ontario Medical Care Incentives

Ontario has discovered another way to please physicians and to encourage them to practise their profession as one might feel they would or should in any event, be prepared to do. Although the province hasn't moved to increase the regular rates for specific medical procedures, it has embarked upon a plan that appears to have been tried elsewhere in the world in an effort to increase medical treatment effectiveness.

It's not only Ontario, but Nova Scotia, Manitoba and British Columbia which have all turned to incentive-payment schemes in the past several years, to mostly affect family practitioners. "Performance pay" has been introduced throughout the United States, with mixed results; a study undertaken by the Rand Corp. found the incentive scheme for California's doctors had not resulted in improvement in the quality of health care.

As well, the United Kingdom has also introduced this type of incentive program, and it would appear that the experience has proven a negative effect. "It has been a large expense and didn't lead to a lot of change", according to a Dalhousie University health economist, studying the concept. The bonuses can add up over time for doctors who sign on:
  • $40 for each diabetic patient managed according to care guidelines;
  • $2,000 for continuing education on adopting electronic health records.
  • 25% premium for treating patients evenings or week-ends;
  • $500 bonus per year for signing up 15 - 49 patients on provincial diabetes registry; additional $500 for 50 or more.
  • $350 for attaching a vulnerable/complex patient to practise;
  • $350 for taking on an unattached mother within two weeks of birth and caring for newborn;
  • $2,000 annually for making at least 24 house calls to six or more patients;
  • $5,000 annual bonus for delivering babies for five or more patients;
  • $2,000 bonus for providing palliative care to four or more patients;
  • $125 for each diabetes or congestive-heart-failure patient managed according to guidelines.
These incentives are peculiar to and vary with the provinces involved. Additional bonuses can be had for convincing patients to accept flu shots; for adopting more efficient treatment of high blood pressure, as well as simply accepting new patients without family doctors. These bonus payments top up regular specific-services fees.

And while there is mixed opinion elsewhere where the concept has been experimented with, doctors in some of the four provinces who have engaged with the concept claim the bonuses have already been seen to be effective. "This stuff works. What these incentives do is translate into better outcomes.

"You've got the funding to do the extra work ... to start chasing down the [patients] who don't come in", according to one Ontario doctor involved with the program. Doctors agree they are able to earn in the range of $4,000 to $8,000 on top of what they already receive for regular performance, by meeting these extra-quality goals.

There are still enough people around who can vividly recall doctors making house calls, knowing their patients sufficiently well to encourage them to accept beneficial treatments; doctors who went out of their way to be fully concerned about the welfare of their patients' health outcomes. They did this on this own, without any additional monetary incentives.

On the other hand, any new initiatives that could have the effect of keeping general practitioners on track as family doctors responsive to the needs of their patients, rather than signing up for turnstyle-type walk-in clinic physician care, or venturing off to become higher-paid specialists cannot do too much harm to an overstressed medical situation in Canada.

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