10/22/13

Physician payments increase 94%


There has been a sharp increase in the number of physicians in Ontario and an even sharper increase in payments to physicians.

Between 2008 and 2012 the number of physicians in Ontario has increased 18.5%.  This growth is offset by population growth only very modestly: the number of physicians per 100,000 population has increased 13.5% over the same period.




Ontario

Supply


2008
2009
2010
2011
2012
 Increase
Total Number of Physicians
23,043
24,515
25,044
26,163
27,300
18.5%

Family Medicine
11,106
11,817
12,170
12,815
13,513
21.7%

Specialists
11,937
12,698
12,874
13,348
13,787
15.5%
Physicians per 100,000 Population
177
187
188
195
201
13.6%
Location
Rural

1,149
1,202
1,216
1,281
1,352
17.7%

Urban

21,870
23,294
23,816
24,868
25,894
18.4%

Total clinical payments to physicians in Ontario over a similar period (2007/8 to 2011/12) have increased much more rapidly: fully 38%. Indeed, since the Liberal government came to power in 2003, the increase is an astonishing 94%. In the most recent year reported (2011-12), the increase was 9.6%.


Total Clinical Payments to Physicians
Ontario Increase
Ontario payments as % of Canadian
Fiscal Year
Ont.
Canada
($’000)
2003–2004
4,896,254
12,423,446

39.4%
2004–2005
5,169,037
13,036,428
5.6%
39.7%
2005–2006
5,766,526
14,068,859
11.6%
41.0%
2006–2007
6,226,168
14,783,971
8.0%
42.1%
2007–2008
6,881,816
16,064,328
10.5%
42.8%
2008–2009
7,751,544
17,676,543
12.6%
43.9%
2009–2010
8,229,822
19,080,485
6.2%
43.1%
2010–2011
8,674,215
20,242,064
5.4%
42.9%
2011–2012
9,506,125
22,068,826
9.6%
43.1%


The largest growth has been in alternative payments to physicians (as opposed to fee-for-service payments, which, until now, have been the norm). Since 2007/8, there has been a whopping 78.4% increase in alternative payment; since 2003/4, we have seen a 430% increase. 

Ontario now accounts for the majority of such "alternative" payments in Canada, with growth in these payments far outstripping other provinces. Indeed by 2011-12, Ontario paid the large majority (66%) of new Canadian annual alternative payments compared with 2003/4.


 Alternative Clinical Payments to Physicians
Fiscal Year
Ont.
Canada
Ontario Increase
Ontario as % of Canada
($’000)
2003–2004
780,111
2,407,743

32.4%
2004–2005
864,973
2,640,732
10.9%
32.8%
2005–2006
1,056,499
2,955,074
22.1%
35.8%
2006–2007
1,379,348
3,208,654
30.6%
43.0%
2007–2008
1,882,571
3,906,053
36.5%
48.2%
2008–2009
2,489,630
4,755,853
32.2%
52.3%
2009–2010
2,680,927
5,085,875
7.7%
52.7%
2010–2011
2,985,798
5,548,758
11.4%
53.8%
2011–2012
3,358,396
6,338,803
12.5%
53.0%
Source: CIHI,  National Physician Database, 2011-12 Data Release  



As Ontario has moved to more alternative payments, it has also assumed a larger share of total Canadian payments to physicians. That raises some question about the efficiency of Ontario's alternative funding mechanisms.

Earlier, the government made some noise about freezing physician incomes, but the 2013-14 Budget Estimates suggest that the line item primarily covering physicians ("Ontario Health Insurance") is going up quite a bit more than the rest of the health care budget, so the trend towards increased funding for Ontario physicians may be continuing. 

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