But how Canada pays its doctors should be on the table, too. The current fee-for-service method – under which physicians bill provincial health plans for every individual procedure they perform – still dominates, even though it encourages unnecessary procedures, unwieldy paperwork and proven fraud.
Ontario has moved to pay some doctors (who volunteer) on a capitation basis – that is, based on the number of patients in their practice rather than the number of times they see them. But a recent study in the CMA Journal suggested that such doctors chose healthier patients who turned more often to hospital emergency wards for non-urgent matters. No savings there.
Quebec’s move to pay some specialists significantly lower fees per service, in exchange for a base salary, has had better results. A recent study in the Journal of Health Economics showed that the doctors performed fewer services, but saw patients longer and devoted more time to teaching, suggesting “a potential quality-quantity substitution.”
Some of the best U.S. hospitals, including the Mayo Clinic and the Cleveland Clinic, employ only salaried doctors working in interdisciplinary teams. So no doctor loses money by not treating a patient.
Still, the vast majority of U.S. doctors, like their Canadian counterparts, cling to the old fee-for-service model. And no government wants to take on the doctors lobby, not when Canadians trust their physicians so much more than their politicians.