Go to Admin » Appearance » Widgets » and move Gabfire Widget: Social into that MastheadOverlay zone
Proponents of disclosure say:
Opponents of disclosure say:
The province pays physicians $ 11 billion annually, most of it in fee-for-service payments through the Ontario Health Insurance Plan (OHIP).
“We are in a world of increased transparency in the expenditure of public funds. The public has a right to know how their dollars are spent and to judge whether they believe they are getting appropriate value,” said former deputy health minister Graham Scott.
THE TOP 100 OHIP billers took in a combined $ 191 million in 2012-13, according to data gleaned from the Star’s FOI request.
Ophthalmologists were the biggest billers, followed by diagnostic radiologists and then cardiologists, according to information provided.
The Star asked in its request for details on the specialties of each of the 100 top billers, but this information was kept secret for 22 physicians, with personal privacy cited as the reason.
Those 22 include the six top billers. The highest biller alone claimed more than $ 6 million, while the second and third highest billers each claimed more than $ 4 million.
The Star asked the province’s acting information and privacy commissioner, Brian Beamish, why the release of physician-identified billings would be considered an unjustified invasion of personal privacy.
He issued the following statement:
“Decisions from the (Information and Privacy Commission) have traditionally treated this information as the personal information of physicians and exempt from disclosure. However, there is a growing trend toward greater transparency, particularly in the area of government expenditures.”
Beamish indicated it might be worth re-examining whether the public interest in such information trumps personal privacy.
He pointed out that in 2010 his office ordered the release of salaries of the chief and deputy chief of the York Regional Police force. The York Regional Police Association had sought the information but the force refused to release it, maintaining the salaries were “personal information.” The association successfully appealed, arguing there was a “compelling public interest” in disclosure.
The Star is appealing the decision by the health ministry to deny that portion of the FOI request related to physician identities.
“An appeal for your particular request regarding the identification of OHIP billings by individual physicians would provide a good opportunity to take a fresh look at this issue,” Beamish wrote.
MICHAEL DECTER, another former deputy minister of health, has long supported the idea of disclosing physician-identified billings and says it was an issue when he worked at Queen’s Park 20 years ago.
“It’s public money; there ought to be public disclosure. I don’t know why we exempt Ontario doctors from what applies to everyone else in the public sector,” Decter argues.
He was referring to Ontario’s so-called Sunshine List, the list of public servants with salaries of more than $ 100,000, which is released every spring. Most doctors are not on the list, and that’s because they are not salaried employees. Doctors who bill OHIP are considered independent contractors.
(The list does include some salaried physicians, for example those working in community health centres.)
The Sunshine List was introduced in 1996 by the Mike Harris government, with the intent of making public servants more accountable to taxpayers.
He points out that Manitoba has been releasing physician-identified billings since 1996 and British Columbia since 1971.
“Transparency in the name of punishment or shaming wouldn’t be useful. But if the purpose for posting physician (earnings) is to educate the public and help make the case why greater reforms and leadership are required from our physicians, as we call for in our report, then it would be a positive step,” he said in an email.
Martin, now chair of the Institute for Competitiveness and Prosperity, released a report earlier this year showing that physician wages jumped a whopping 51 per cent between 2002 and 2012, making Ontario doctors the best-paid in the country, with earnings (before overhead costs) averaging $ 375,000.
But the investment didn’t buy much-needed reforms, and the report says Ontario’s health system continues to underperform compared with other developed jurisdictions worldwide on factors such as wait times and access.
Scott, who chaired the province’s negotiating team during the last round of contract talks, in 2012, said transparency and accountability go hand in hand.
“It is hard to justify confidentiality with regard to the expenditure of public funds. It is also hard to have accountability where there is no transparency. I believe doctors, like all others supported by the public, should accept that their income be made public and if necessary be prepared to defend it,” says Scott, who today wears many hats, including chair of the Institute for Research in Public Policy.
More accountability would mean, for example, that physicians would be required to meet performance targets and work in teams with other health professionals, he says. Patients would get quick appointments with family doctors, and sizable inequities in payments to various specialty groups would shrink.
Physicians known as “cognitive specialists” get paid much less than those known as “procedural specialists.”
The proceduralists include ophthalmologists, cardiologists and surgeons. They do identifiable procedures, reliant on technology-intensive expertise.
Disparities between what the two groups are paid have grown over time, driven largely by advances in technology that allow procedures to be done much faster. OHIP fees have not proportionately changed.
The oft-cited example is cataract surgery. A procedure that once took a couple of hours and required a multi-day hospital stay can now be done in 15 minutes on an outpatient basis.
Warning that the future of medicare is at stake, Scott says it’s essential to have transparency and accountability from all corners of the health system.
“The public remain strongly supportive of medicare, but they are aware that there is a sustainability challenge,” Scott says, referring to the fact the province last year spent $ 51 billion on health care, or 42 per cent of the provincial budget.
“In that context, they should have all the facts, not just about hospitals, hospital administrators, drug costs, etc., but also the payments to doctors and about the inequities in payments among highly skilled physicians,” he adds.
OMA PRESIDENTDr. Ved Tandan declined to be interviewed for this story, but in an emailed statement, he expressed concern about publication of billings.
“We support transparency, but it must serve a clear purpose and help to inform the public, and simply posting OHIP billings would be misleading to the public as those numbers do not represent what a physician earns,” he said. “So we must ask what is the value of having incomplete information posted and how will this improve access, quality or transparency?”
There are very legitimate reasons for some doctors to have high billings, Vandan wrote.
“In underserviced areas, these numbers may be higher for individual physicians because there are fewer physicians who are working to meet the needs of that population while in others, they may be higher for physicians working on reducing waiting lists under the government’s Wait Time Strategy,” he said, referring to a program that aims to cut waits for such procedures as cancer surgery, hip and knee replacements and MRI scans.
DAVID HENRY, a professor at the University of Toronto’s Institute of Health Policy Management and Evaluation, is also opposed to public disclosure of physician-identified billings.
“What is the benefit to society of naming the individual if the individual is providing a needed service?” asked Henry, former president of the Institute for Clinical Evaluative Sciences and co-author of a study on physician payments.
“If the idea is that they are being shamed, I don’t see the sense of it,” he says.
He also points out that OHIP payments only tell part of the story. While 95 per cent of physicians derive at least some of their income from fee-for-service payments, doctors also get paid through other methods. For example, some get annual fees for each patient signed up with them (capitation), others get salaries and others are compensated through a mix of payment models.
BRIAN GOLDEN, who holds the Sandra Rotman chair in health sector strategy at the University of Toronto and the University Health Network, is another opponent of disclosure.
“If we are simply curious about the lives of the rich and famous, then I am not sure how much that improves a health system,” he says.
Golden cautioned that the release of billings could have a detrimental effect in small communities where physician shortages force a small number of doctors to put in long hours.
Golden says physician-identified billing data isn’t particularly useful in helping taxpayers determine if they are getting good value for money.
“They won’t understand from the data whether someone is working 40 hours a week or 60 hours a week because that is never reported. And they won’t know the difference between someone providing average quality care and someone who is providing exceptional quality of care,” he says.
Complicating matters further, as many people interviewed for this article pointed out, is that many top-billing physicians are clinic owners who put claims in to OHIP not just for their own work, but also for the services of other doctors who work for them. They include pathologists and cardiologists who, for organizational purposes, run other doctors’ claims through their own OHIP billing numbers.
With data analysis by Andrew Bailey.