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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...2012–2013 (130413). (2013). Retrieved from Majesty the Queen in Right of Canada website: http://www.hc-sc.gc.ca/hcs-sss/alt_formats/pdf/pubs/cha-ics/2013-cha-lcs-ar-ra-eng.pdf
Blomqvist A., Busby C., (2012). How to pay family doctors: Why “pay per patient” is better than fee for service. C.D. Howe Institute Commentary, Commentary 365.
Lischko A. (2011). Physician payment reform: A review and update of the models. Massachusetts medical society.
Xu, M & Yu, W. (2003). Physician payment options: A policy discussion for New Brunswick. University of New Brunswick Department of Health and wellness.
Chawla, M., Windak, A., Berman, P., & Kulis, M. (1997). Paying the Physician: Review of Different Methods. Data for Decision Making Project,Department of Population and International Health, Harvard School of Public Health, Boston, Massachussetts
Saskatchewan’s governmental agencies approach to the shortage of doctors in the province favors too much the structuralist approach and would be more effective in the long term if switched to a humanistic approach. Throwing money at a problem may work for a little bit but what happens when the money runs out? So are current programs a true fix or a short-term solution doomed to fail. We look at the possible causes for the shortage of doctors and then examine the governmental responses put in place to deal with the problem, both past and present. We look at which perspectives are more successful between the structuralist approach and the humanist approach when it comes to the Canadian health care system.
An analysis of the US and Canada’s systems reveals advantages and drawbacks within each structure. While it is apparent that both countries could benefit from the adoption of portions of the others system, Canada’s healthcare system offers several benefits over the US system.
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,
LaPierre, T. A. (2012). Comparing the Canadian and US Systems of Health Care in an Era of Health Care Reform. Journal of Health Care Finance, 38(4), 1-18.
In this paper, there will be a comparative analysis to the United States (U.S.) healthcare system and Canadians healthcare system highlighting the advantages and disadvantages of both.
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 ...
Miller, H. D. (2009). From volume to value: better ways to pay for health care. Health Affairs
Hicks, L. (2012). The Economics of Health and Medical Care (6th Ed.). Sudbury, MA: Jones and Bartlett Publishers.
Gordon, M., Mintz, J., & Chen, D. (1998). Funding Canada’s health care system: A tax based alternative to privatization. Canadian Medical Association, 159 (5), 493-496.
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
Levit, K. R., & Cowan, C. A. (1991). Business, households and governments: Health care costs, 1990. Health Care Financing Review, 13 (2), 83. Retrieved from: Ashford University Library
Thompson, R, 2005 “Is Pay for Performance Ethical?” The Physician Executive, Nov-Dec 2005, pp 60-63
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
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
The cost of US health care has been steadily increasing for many years causing many Americans to face difficult choices between health care and other priorities in their lives. Health economists are bringing to light the tradeoffs which must be considered in every healthcare decision (Getzen, 2013, p. 427). Therefore, efforts must be made to incite change which constrains the cost of health care without creating adverse health consequences. As the medical field becomes more business oriented, there will be more of a shift in focus toward the costs and benefits, which will make medicine more like the rest of the economy (Getzen, 2013, p. 439).