High billing not just an administrative issue

Ontario’s privacy commission has taken a bold step by ordering that the health ministry to release the names of doctors along with their OHIP billings, in the interests of transparency and accountability.

In the light of this order Ontarians would be able to know how much their doctors are billing the province health insurance plan annually.  Doctors’ remuneration, public money that has long remained confidential had become a contentious matter for the province at a time when Ontario is facing a provincial debt of close to $ 300 billion.

The ruling brings an interesting turn of events when the Ontario Medical Association (OMA) and the Ontario government are engrossed in negotiations over the fees paid to the physicians. Ontario annually discloses the salaries of all public-sector workers paid more than $100,000. The salaries of the small minority of doctors who are on salary at public hospitals are disclosed on the list, but doctors who bill OHIP on a fee-for- service basis are exempt. Whereas Doctorstotal annual billings in British Columbia and Manitoba are public.

Health minister Eric Hoskins had criticized certain specialists without naming them for the large sums they bill. The matter had come to light when mainstream media carried reports and highlighted that about 50 doctors from an area spread over only 150 kilometers in Ontario billed OHIP for at least $ 1 million last year, including an ophthalmologist who billed the provincial health insurance plan a “staggering” $6.6 million. The top five in that list include two ophthalmologists, two radiologists and one anesthesiologist, but their names and workplaces weren’t released. “I need to set the record straight,” Health Minister Eric Hoskins had said at a newsconference in Toronto. And this response “This isn’t about hard-working family doctors or pediatricians,” had not gone well with the Ontario Medical Association (OMA). Doctors too reacted to the Health Minister and responded by saying that medical practices are expensive to run.

Premier Kathleen Wynne has the option where by Ontario can appeal the ruling in the court. “Am not going to second guess what the information and privacy commission has said,” Wynne told reporters last week in Ottawa. “l work with the information and privacy commissioner to comply with what he has proposed.A welcome step. However, certain more information coming from London, ON, where a single radiologist fills up at seven London area hospitals and the report says that the situation could be similar in remote areas of Ontario too. State of affairs of such a kind should not only get as a case of high OHIP billing but also highlight the lack of infrastructure. As per health minister the province spends $11 billion a year on physician compensation, but has to find hundreds of millions of dollars more at year’s end because there are no caps on billings by doctors, who make an average of $368,000. Health minister Eric Hoskins went on to say that he was not there to demonize high paid doctors, but wanted to highlight fees that were based on a time when it took much longer for radiologists to read a scan and for an ophthalmologistto perform cataracts surgery. He expressed his concern that doctors spend more than they are budgeted, going over by $744 million the last four years. “It has certainly compromised our ability to make other investments.” With more patients, less hospitals, and even lesser doctors the problem of certain doctors getting high billing done.

The issue raised by the high billing is not a problem in isolation. The predicament ofno doctors in hospitals, long waiting times and a host of foreign trained doctors not being considered at par are some of the others that cripple the health system. The recommendation of Ontario’s privacy commission, the assurance by Premier to not go to the court are all an indication of a good start but still are not enough. For an effective and efficient health care, a supportive healthcare infrastructure is desired that can keep pace with the development in various cities. OHIP should take figure from the Canadian Immigration and ascertain how well and how fast foreign trained doctors can be made part of the system. The problem needs to be addressed from the perspective of the recipients of the services- the patients and from an administrative angle alone.