Authors' objectives: 1. To estimate public payments to individual physicians from multiple sources between 1992/3 and 2009/10 and report these by specialty, specialty group and overall using several different measures: - the average payment per physician; - the median (and selected percentiles) of the distribution of payments, which illustrates the range of payment levels; - the total of all payments to physicians in a given group. 2. To analyze and report on changes in overall physician supply and in the main specialty groups between 1992/93 and 2009/10, as supply is an important component of expenditure. 3. To analyze how payments and supply varied between the main specialty groups, and how each contributed to the rise in overall physician payments. 4. To analyze how changes in the different types of payments (fee for service and other models) contributed to the observed increases in total payments and payments to physicians.

Authors' recommendations: Physician payments comprise approximately 20% of total health care costs in Ontario. Although overall physician supply rose in line with population growth, it varied substantially among specialties. The rise in physician payments since the turn of the century was considerably greater than the overall growth in physician numbers and has been growing significantly above the average rate of inflation since 2004/05. Directed increases in physician payments through negotiated agreements with the OMA in 2004 and 2008 were aimed primarily at improving patient access to primary care and reducing wait times. Primary care-related policies represent the largest financial investment in doctors that has been made by the provincial government. The most important positive change resulting from these policies has been the reversal of the decline in numbers of GP/FPs seen in the 1990s. Much of this impact appears to have been related to the change in financial models, with a shift from fee for service to capitation-based payments. Efforts to reduce wait times in a fee-forservice environment have disproportionately benefited key surgical, medical procedural and diagnostic specialties. These groups have also gained financially from demographic changes, technological advances and increased health system capacity (i.e., increased hospital funding) that have enabled larger numbers of services to be provided by certain specialists in recent years. The government of Ontario spent $8 billion on physician services in 2009, $4.3 billion more than in 1992. This investment has resulted in more practising physicians and an increase in services, particularly in areas targeted by certain policies. Alternative payment plans have supported certain government priorities and policy directions, particularly in general/family practice and the non-procedural medical specialties. This report cannot answer whether increased investment has led to better patient outcomes or improved functioning of the health care system. To our knowledge, no such impact analysis has been undertaken. We believe this subsequent work is critical to ensuring that taxpayer dollars invested in the health care system provide maximal benefits for the patients of Ontario.

Project Status: Completed

Year Published: 2012

URL for published report: http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf

URL for additional information: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=68

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute for Clinical Evaluative Sciences

Contact Address: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto ON, Canada, M5N 3M5. Tel: 416-480-4055; Fax: 416-480-6048

Contact Name: info@ices.on.ca

Contact Email: info@ices.on.ca

Copyright: Institute for Clinical Evaluative Sciences (ICES)