Introduction
It is generally accepted that the method of payment to physicians affect their professional attitude and behaviour. Consequently, health policy makers manipulate payment system in an attempt to achieve optimal health care for their citizens such as improve accessibility, quality of care, patient’s satisfaction and cost containment. In Ontario, there are a wide range of mechanisms that are used to pay physicians for their services that are funded by both federal and provincial government. According to Canada Health Act annual report (2013), the majority of primary healthcare physicians are funded using the fee for service payment arrangement but of that majority, only less than 30% are compensated exclusively according the fee for service plan. The remaining physicians are funded using one of the following mixed compensation models:
1. Enhanced Fee-for-service: Family Health Groups (FHG), Comprehensive Care Model
2. Blended Capitation Models: Family Health Network(FHN) , Family Health Organization (FHO)
3. Blended Complement Model : Rural and Northern Physician Group Agreements (RNPGA)
4. Blended Salary Model: Community sponsor Family Health Team (FHT)
Each model presents different types of earning incentives for physicians to provide cost effective care which improves clinical outcome.
This paper will conduct a cost benefit analysis of the three underlying methods that are either used solely or blended together to pay physicians in Ontario. It will compare and contrast Fee for service, capitation, and salary model. This paper will explore the impact of these models on quality and quantity of the primary health care system.
Fee for Service
Fee for Service is the most common and also the most accused metho...
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The Saskatchewan heath care system is made up of several provincial, regional and local organizations, which provide the people their basic right to reasonable health care (“Health Systems,” 2014). Not having enough health care providers seem to be a problem, which Canada as a whole has struggled with (“College of Family,” 2014). The shortages of medical providers have lead to major discrepancies in the level of patient care between major urban centers and rural areas (Howlett, 2013). In the case of Saskatchewan many communities are facing this challenge, not only rural areas but also the capital city of the province (“Saskatchewan ER,” 2013). Stats Canada has showed that the number of physicians is at a historic high, yet Saskatchewan still face shortages (Howlett, 2013).
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
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Just as the economy travels through its cycles, from bear to bull and back again, so does the number of doctors in the country. In the 1960s, the government began an attempt to create more physicians using various methods. One such method was to reward medical schools for training a certain number of doctors (Bernstein 1013). This would give the medical schools an incentive to accept more students and to allow the students to fully graduate and go on to attend residency programs. Another such method was to give a monetary reward to residency programs for providing graduate medical education. This totaled approximately $7 billion, a sum large enough to “pay the tuition and living expenses of every medical student in the United States” with a large portion left over as well (Bernstein 1013). Because of these actions taken by the government, many more physicians were created, causing a physician surplus throughout the 1980s to the late 1990s, although this claim was based on ...
The public health care system in Canada is still flawed, proven through the wait times that many patients have to go through. Canadians may wait up to six to nine months for “non-urgent” MRIs . The waiting list is dreary for Canadians, unlike Americans who can get their services immediately through paying out-of-pocket, the long public sector in Alberta waits up to a year for services, the wait for cataract surgery was six weeks ; these waits for some patients put the public health care system to shame, and helps push the idea of the privatized health care system a bettering option for the future of the nation. Additionally, 41 percent of adult Canadians said they experienced a difficulty in accessing hospital and physician care on weekday nights and weekends . Furthermore, it is still evident that Canadians in fact pay a higher income tax compared to Americans, due to the fact that they are paying the fund the health care system through their taxes; however, it is still significantly less to pay for a public health care system than it is privatized . Privatization is further proved as a superior choice with regards to the discharge situation many Canadians face. In Canada, it is common to see patients discharged earlier than recommended due the rising amount of patients using the free-of-charge public health care system, patients are released “quicker and sicker” because of this . Additionally, when discharged, the public health care system does not cover home care and private nurse care ; further proving the notion that there is still some forms of privatization already in the health care system in
The fourth key point is payment models. In order to make sure quality health care is given across the board you have to follow the money. In this section it talks about an idea of restructuring the payment scheme. Using bundled payments “offer the potential for promoting equity by redirecting resources to health care values...
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
Romanow, R. (n.d.). Building on Values: The Future of Health Care in Canada. Collections Canada. Retrieved from http://www.collectionscanada.gc.ca/webarchives/20071122004429/http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/hcc_final_report
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Outpatient Payments Philosophy As CMS dictates the nature of medical reimbursement, the adjustments made by CMS to outpatient payment models have drastic effects, many of which are often unintentional. Cost efficiency clearly finds itself on the top of the United States healthcare priority list, therefore placing extreme pressure on CMS to somehow find a “better” way to pay for care. The definition of “better” relies on not only causal relationships of care effectiveness, but also on simple morality of ensuring this payment model encourages the best possible setting for care.
Fee-For-Service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying cost sharing by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is the dominant physician payment method in the United States, it raises costs, discourages the efficiencies of integrated care, and a variety of reform efforts have been attempted, recommended, or initiated to reduce its influence.
retrospect to its governing authority (Shi & Singh, 2012). However, private and public agencies are the controlling constituent in today’s business. Free markets allow patients to choose providers without the prior approval of insurance companies. The current system offers a proposed plan of limited physicians in exchange for payment of services. Because the potential has been given to the payers, they regulate the cost of services rendered through contractual
Shimko, D., (2013). Choosing a Pay Structure that Works for Your Practice, Retrieved December 14, 2013 from Internet http://www.aafp.org/fpm/2000/0200/p30.html