A Wasted Opportunity for Reform

The Government has imposed a series of cuts on Ontario Doctors after negotiations with the OMA did not lead to an agreement.

A major concern with this failure is that no positive reforms have been implemented.

The OMA and the Government negotiate a new contract every 3-5 years. It is a chance to set fees, usually increases, but of late fee decreases. It is also a chance to agree to implement policy initiatives that will improve patient care and the system in general.

In negotiated agreements in 2000, 2005 and 2008 fees and other payments were increased. In addition policies were implemented about Primary Care Reform, Electronic Medical Records for physicians, an Academic Alternate Funding Plan, an Emergency Department funding model, an Innovation Fund, Patient Enrolment Models of primary care including FHGs and FHOs, stabilization of Hospital On-Call, enhancements to Palliative Care, Care of the Elderly and HIV Care. We agreed on how to pay Medical Officers of Health and CHC physicians and we introduced $40 million of funding for primary care nurses. The list is much longer but I have made my point that contracts between Government and Doctors can be about much more that how much Doctors get paid. They can and should be focused on how we can improve patient care.

Even in 2012 in a contract that identified $850 million in savings, some positives for patients were introduced. Agreement was made about curtailing certain tests that were not only of questionable value  and potentially harmful. We also introduced Quality Improvement Plans to Family Doctors practising in Family Health Teams.

In this last failed negotiation, no positive reforms have been identified.

That might be acceptable if we had a perfect or near perfect health system with no need of change. One would have to look long and hard to find anyone, even the most ardent Government supporter, who did not think that the Health system needs reform.

For starters we need to improve access to family doctors and specialists. We have done a good job at finding family doctors for unattached patients and now we need to improve the number of people who can see their family doctor in a timely manner. Similarly we need to shorten waiting lists to specialists and make sure that resources are in place to support treatment.

We need to remove barriers to providing care in the community. Hospital care is very expensive Community care is less expensive and can be much more comfortable for patients and families.

We need to improve the relationships between other providers, other institutions and doctors. We need to engage Physicians. We need their leadership.

We need to review the Alternate Funding Plans to see what changes are needed to better suit the needs of patients. This includes but is not limited to, the Academic Alternate Funding Plan,  Primary Care payment models and Emergency Department Alternate Funding Plans.

And we need to do something to improve Quality. What is the process for implementing recommendations from Choosing Wisely Canada, the Ontario Health Technology Assessment Committee and other credible evidence sources? There is none.

And surely we need to improve End of Life Care. It’s in the speech from the Throne, the Budget but not in the Government’s unilateral actions.

That’s why an agreement rather than a unilateral imposition is so important. We have a lot of work to do to build a sustainable system. Let’s get at it.

Scott Douglas Wooder, MD

Next an historic look at reconciliation-Clawbacks

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