2015 Ontario Health Cut Backs: Overview and Specific Impact on Primary Care
Barre latérale de l'article
Publié-e :
mai 22, 2015
Mots-clés :
family practice, family medicine, primary care, government, ministry of health
Contenu principal de l'article
Résumé
On February 1st 2015, the Ontario government began implementing a series of unilateral cut-backs to health care in Ontario. These changes include a 2.65% decrease to physician fees across-the-board, restricting entry into Family Health Organizations (FHO) and Family Health Networks (FHN), discontinuing enrolment premiums, and restricting the Income Stabilization program [1-7]. Without a doubt, family physicians are amongst the most heavily impacted physicians [8]. In this commentary, we attempt to summarize the recent events leading to these cut-backs, and discuss the potential implications of these changes with relation to primary care in particular.
Renseignements sur l'article
Rubrique
Commentary
- Les auteurs qui publient dans le JMUO gardent les droits d’auteur de leurs articles, incluant tous les brouillons et la copie finale publiée dans le journal
- Bien que le JMUO n’a pas les droits d’auteur des articles soumis, en acceptant de publier dans le JMUO, les auteurs donnent le droit au journal d’être les premiers à publier et à distribuer leurs articles.
- Par la suite, les auteurs peuvent soumettre leurs documents à d’autres publications, incluant des revues ou des livres, avec un remerciement de leur première publication dans le JMUO
- Des copies du JMUO seront distribuées à la fois sous format papier et en ligne, et tous les matériaux seront accessibles au public en ligne. Le journal n’a pas de responsabilité légale par rapport à la distribution publique du contenu.
- Prière de vous assurer que tous les auteurs, les coauteurs et les investigateurs
- Le contenu est rendu disponible sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
Références
References:
1) “Physician Services: ten-point plan for saving and improving service” [Internet]. Ontario Government Newsroom. 2015 Jan 15. [updated 2015 Jan 15; cited 2015 Mar 27]. Available from: http://www.news.ontario.ca/mohltc/en/2015/01/physician-services-ten-point-plan-for-saving-and-improving-service.html
2) Summary of Government’s Proposed Unilateral Action. OMA Media Release. 2014-2015.
3) Memorandum of Agreement between Her Majesty the Queen Right of Ontario, represented by the Minister of Health and Long Term Care and OMA. 2014 Dec 5 [updated 2015 Jan 9].
4) INFOBulletin - Payment Discount - Non-fee-for-service physician payment programs. Health Services Branch. 2015 Feb 17. Bulletin 4648. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4648.pdf
5) INFOBulletin - Continuing Medical Education Reimbursement Profram for Course/Product Expenses Discontinued. 2015 Feb 12. Bulletin 4647. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4647.pdf
6) INFOBulletin - Changes to Primary Health Care Physician Payments. 2015 Feb 12. Bulletin 1125. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/11000/bul11125.pdf
7) INFOBulletin - Amendments to the Schedule of Benefits for Physician Services and Payment Discount of 2.65%. 2015 Feb 12. Bulletin 4646. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/11000/bul4646.pdf
8) MOHLTC Unilateral Action, by specialty. 2015 Jan 2015.
9) “Ontario slashes fees it pays to doctors following negotiations” [Internet]. Globe and Mail. 2015 Jan 15 [updated 2015 Feb 17; cited 2015 Mar 20]. Available from: http://www.theglobeandmail.com/news/politics/labour-talks-founder-between-ontario-and-doctors/article22461657/
10) “2012 Physician Services Agreement between OMA and Her Majesty the Queen Right of Ontario, represented by the Minister of Health and Long Term Care”. 2012 Physician Service Agreement. 64 p.
11) “New agreement between Ontario’s doctors and government protects patient care” [Internet]. OMA Press Release. 2012 Dec 9. [updated 2012 Dec 9; cited 2015 Mar 28]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/Newagreement.aspx
12) “OMA stands up for patients and rejects government’s offer as it will negatively impact patient care” [Internet]. OMA Press Release. 2015 Jan 15. [updated 2015 Jan 15; cited 2015 Mar 26]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/OMArejectsgovernmentsoffer.aspx
13) “Mid-year update on Ontario’s Economic and Fiscal Performance”. Ontario Ministry of Finance. 2014 Nov 17. [updated 2014 Nov 17; cited 2015 Mar 29]. Available from: http://www.fin.gov.on.ca/en/budget/fallstatement/2014/bk2.html
14) The Honourable Dwight Duncan - Minister of Finance. Public Accounts of Ontario 2008-2009. Annual Report and Consolidated Financial Statements. Toronto, Ontario. 2009 August. [updated 2010 May 14; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2009/09_ar.html
15) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2009-2010. Toronto, Ontario. 2010 August. [updated 2010 Sept 7; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2010/10_ar.html
16) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2010-2011. Toronto, Ontario. 2011 August. [updated 2011 Aug 23; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2011/10_ar.html
17) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2011-2012. Toronto, Ontario. 2012 August. [updated 2011 Sept 30; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2012/10_ar.html
18) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2012-2013. Toronto, Ontario. 2013 September. [updated 2013 Sept 10; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2013/10_ar.html
19) The Honourable David Onley - Lieutenant Governor of Ontario. Ministry of Finance Public Accounts of Ontario: 2013-2014. Annual report and consolidated financial statements. Toronto, Ontario. 2014 September. [updated 2014 Sept 10; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2014/14_arcfs.pdf
20) “Ontario doctor’s expect productive dialogue on important health issues as Legislature resumes” [Internet]. OMA Press Release. 2015 Feb 17. [updated 2015 Feb 17; cited 2015 Mar 22]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/productivedialogue.aspx
21) “Ontario doctors reject the province’s contract offer” [Internet]. CBC News. 2015 Jan 15. [updated 2015 Jan 19; cited 2015 Mar 23]. Available from: http://www.cbc.ca/news/canada/toronto/ontario-doctors-reject-province-s-contract-offer-1.2911779
22) “Ontario’s doctors exploring all options to get back to the negotiating table” [Internet]. OMA Press Release. 2015 Mar 27. [updated 2015 Mar 27; cited 2015 Mar 28]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/exploringalloptions.aspx
23) Impact of Government Unilateral Action on Family Medicine and Primary Care Physicians. OMA Media Release. 2015.
24) “Family Practice Models” [Internet]. Health Force Ontario. Last modified: May 3, 2013. Available from:http://www.healthforceontario.ca/en/Home/Physicians/Training_%7C_Practising_Outside_Ontario/Physician_Roles/Family_Practice_Models.
25) “Guide to Physician Compensation”. Ontario Family Health Teams. 2009 September. Version 3.0.
26) Hospital On-Call Coverage Program [Internet]. Ontario Ministry of Health and Long Term Care. 2013 Apr 16 [updated 2013 Apr 16; cited 2015 Mar 20]. Available from: http://www.health.gov.on.ca/en/pro/programs/hocc/hocc_guide.aspx
27) Education and Prevention Committee Interpretive Bulletin. Chronic disease Assessment Premium: Code E078. Toronto, Ontario. Ontario Medical Association. 2007 Jan. 3 p. Report no.: Volume 5, No 2.
28) “Fed-up doctors plan to use five-minute timer to make their case” [Internet]. Windsor Star News. 2015 Feb 16. [updated 2015 Feb 16; cited 2015 Mar 26]. Available from: http://blogs.windsorstar.com/news/fed-up-doctors-plan-to-use-five-minute-timer-to-make-their-case
29) Mulligan, C. “Docs want fair deal” [Internet]. Sudbury Star. 2015 Jan 25. [updated 2015 Jan 25; cited 2015 Mar 23]. Available from: http://www.thesudburystar.com/2015/01/25/docs-want-fair-deal
30) Elia, M. “Clawbacks to Ontario MDs: The absurdity of it all” [Internet]. Blog. 2015 Mar 15. [updated 2015 Mar 22; cited 2015 Mar 27]. Available from: https://drmarioelia.wordpress.com/2015/03/
31) Wooder, S. “Reconciliation – the Trojan horse of Ontario health cuts” [Internet]. Blog. 2015 Feb 4.[updated 2014 Feb 4; cited 2015 Mar 21]. Available from: https://drscottwooder.wordpress.com/2015/02/04/reconciliation-the-trojan-horse-of-ontario-health-cuts/
32) Elia, M. “Ontario doctors vs. the Ontario government: we need better” [Internet]. Healthy Debate. 2015 Jan 21 [updated 2015 Jan 21; cited 2015 Mar 23]. Available from: http://healthydebate.ca/opinions/ontario-mds-vs-ontario-government-need-better
33) “Stop limiting where new physicians can practice, Ontario doctors tell government” [Internet]. OMA Press Release. 2015 March 25. [2015 March 25; cited 2015 March 27]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/stoplimiting.aspx
34) Cargill, D. “Health care cuts will have lasting impact”. [Internet]. Letter to the Editor. Windsor Star. 2015 Jan 20. [updated 2015 Jan 20; cited 2015 Mar 19]. Available from: http://blogs.windsorstar.com/open-newsroom/letters/health-care-cuts-will-have-lasting-impact
35) “OHIP billings do not equal salary” [Internet]. OMA Press Release. 2014 Dec 9. [updated 2014 Dec 9; cited 2015 Mar 26]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/OHIPBillingsDoNotEqualSalary.aspx
1) “Physician Services: ten-point plan for saving and improving service” [Internet]. Ontario Government Newsroom. 2015 Jan 15. [updated 2015 Jan 15; cited 2015 Mar 27]. Available from: http://www.news.ontario.ca/mohltc/en/2015/01/physician-services-ten-point-plan-for-saving-and-improving-service.html
2) Summary of Government’s Proposed Unilateral Action. OMA Media Release. 2014-2015.
3) Memorandum of Agreement between Her Majesty the Queen Right of Ontario, represented by the Minister of Health and Long Term Care and OMA. 2014 Dec 5 [updated 2015 Jan 9].
4) INFOBulletin - Payment Discount - Non-fee-for-service physician payment programs. Health Services Branch. 2015 Feb 17. Bulletin 4648. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4648.pdf
5) INFOBulletin - Continuing Medical Education Reimbursement Profram for Course/Product Expenses Discontinued. 2015 Feb 12. Bulletin 4647. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4647.pdf
6) INFOBulletin - Changes to Primary Health Care Physician Payments. 2015 Feb 12. Bulletin 1125. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/11000/bul11125.pdf
7) INFOBulletin - Amendments to the Schedule of Benefits for Physician Services and Payment Discount of 2.65%. 2015 Feb 12. Bulletin 4646. Available from: http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/11000/bul4646.pdf
8) MOHLTC Unilateral Action, by specialty. 2015 Jan 2015.
9) “Ontario slashes fees it pays to doctors following negotiations” [Internet]. Globe and Mail. 2015 Jan 15 [updated 2015 Feb 17; cited 2015 Mar 20]. Available from: http://www.theglobeandmail.com/news/politics/labour-talks-founder-between-ontario-and-doctors/article22461657/
10) “2012 Physician Services Agreement between OMA and Her Majesty the Queen Right of Ontario, represented by the Minister of Health and Long Term Care”. 2012 Physician Service Agreement. 64 p.
11) “New agreement between Ontario’s doctors and government protects patient care” [Internet]. OMA Press Release. 2012 Dec 9. [updated 2012 Dec 9; cited 2015 Mar 28]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/Newagreement.aspx
12) “OMA stands up for patients and rejects government’s offer as it will negatively impact patient care” [Internet]. OMA Press Release. 2015 Jan 15. [updated 2015 Jan 15; cited 2015 Mar 26]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/OMArejectsgovernmentsoffer.aspx
13) “Mid-year update on Ontario’s Economic and Fiscal Performance”. Ontario Ministry of Finance. 2014 Nov 17. [updated 2014 Nov 17; cited 2015 Mar 29]. Available from: http://www.fin.gov.on.ca/en/budget/fallstatement/2014/bk2.html
14) The Honourable Dwight Duncan - Minister of Finance. Public Accounts of Ontario 2008-2009. Annual Report and Consolidated Financial Statements. Toronto, Ontario. 2009 August. [updated 2010 May 14; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2009/09_ar.html
15) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2009-2010. Toronto, Ontario. 2010 August. [updated 2010 Sept 7; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2010/10_ar.html
16) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2010-2011. Toronto, Ontario. 2011 August. [updated 2011 Aug 23; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2011/10_ar.html
17) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2011-2012. Toronto, Ontario. 2012 August. [updated 2011 Sept 30; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2012/10_ar.html
18) The Honourable David Onley - Lieutenant Governor of Ontario. Annual Report and Consolidated Financial Statements 2012-2013. Toronto, Ontario. 2013 September. [updated 2013 Sept 10; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2013/10_ar.html
19) The Honourable David Onley - Lieutenant Governor of Ontario. Ministry of Finance Public Accounts of Ontario: 2013-2014. Annual report and consolidated financial statements. Toronto, Ontario. 2014 September. [updated 2014 Sept 10; cited 2015 Mar 27]. Available from: http://www.fin.gov.on.ca/en/budget/paccts/2014/14_arcfs.pdf
20) “Ontario doctor’s expect productive dialogue on important health issues as Legislature resumes” [Internet]. OMA Press Release. 2015 Feb 17. [updated 2015 Feb 17; cited 2015 Mar 22]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/productivedialogue.aspx
21) “Ontario doctors reject the province’s contract offer” [Internet]. CBC News. 2015 Jan 15. [updated 2015 Jan 19; cited 2015 Mar 23]. Available from: http://www.cbc.ca/news/canada/toronto/ontario-doctors-reject-province-s-contract-offer-1.2911779
22) “Ontario’s doctors exploring all options to get back to the negotiating table” [Internet]. OMA Press Release. 2015 Mar 27. [updated 2015 Mar 27; cited 2015 Mar 28]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/exploringalloptions.aspx
23) Impact of Government Unilateral Action on Family Medicine and Primary Care Physicians. OMA Media Release. 2015.
24) “Family Practice Models” [Internet]. Health Force Ontario. Last modified: May 3, 2013. Available from:http://www.healthforceontario.ca/en/Home/Physicians/Training_%7C_Practising_Outside_Ontario/Physician_Roles/Family_Practice_Models.
25) “Guide to Physician Compensation”. Ontario Family Health Teams. 2009 September. Version 3.0.
26) Hospital On-Call Coverage Program [Internet]. Ontario Ministry of Health and Long Term Care. 2013 Apr 16 [updated 2013 Apr 16; cited 2015 Mar 20]. Available from: http://www.health.gov.on.ca/en/pro/programs/hocc/hocc_guide.aspx
27) Education and Prevention Committee Interpretive Bulletin. Chronic disease Assessment Premium: Code E078. Toronto, Ontario. Ontario Medical Association. 2007 Jan. 3 p. Report no.: Volume 5, No 2.
28) “Fed-up doctors plan to use five-minute timer to make their case” [Internet]. Windsor Star News. 2015 Feb 16. [updated 2015 Feb 16; cited 2015 Mar 26]. Available from: http://blogs.windsorstar.com/news/fed-up-doctors-plan-to-use-five-minute-timer-to-make-their-case
29) Mulligan, C. “Docs want fair deal” [Internet]. Sudbury Star. 2015 Jan 25. [updated 2015 Jan 25; cited 2015 Mar 23]. Available from: http://www.thesudburystar.com/2015/01/25/docs-want-fair-deal
30) Elia, M. “Clawbacks to Ontario MDs: The absurdity of it all” [Internet]. Blog. 2015 Mar 15. [updated 2015 Mar 22; cited 2015 Mar 27]. Available from: https://drmarioelia.wordpress.com/2015/03/
31) Wooder, S. “Reconciliation – the Trojan horse of Ontario health cuts” [Internet]. Blog. 2015 Feb 4.[updated 2014 Feb 4; cited 2015 Mar 21]. Available from: https://drscottwooder.wordpress.com/2015/02/04/reconciliation-the-trojan-horse-of-ontario-health-cuts/
32) Elia, M. “Ontario doctors vs. the Ontario government: we need better” [Internet]. Healthy Debate. 2015 Jan 21 [updated 2015 Jan 21; cited 2015 Mar 23]. Available from: http://healthydebate.ca/opinions/ontario-mds-vs-ontario-government-need-better
33) “Stop limiting where new physicians can practice, Ontario doctors tell government” [Internet]. OMA Press Release. 2015 March 25. [2015 March 25; cited 2015 March 27]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/stoplimiting.aspx
34) Cargill, D. “Health care cuts will have lasting impact”. [Internet]. Letter to the Editor. Windsor Star. 2015 Jan 20. [updated 2015 Jan 20; cited 2015 Mar 19]. Available from: http://blogs.windsorstar.com/open-newsroom/letters/health-care-cuts-will-have-lasting-impact
35) “OHIP billings do not equal salary” [Internet]. OMA Press Release. 2014 Dec 9. [updated 2014 Dec 9; cited 2015 Mar 26]. Available from: https://www.oma.org/Mediaroom/PressReleases/Pages/OHIPBillingsDoNotEqualSalary.aspx