Auditor questions whether access to doctors is better

TORONTO - Many Ontario doctors are collecting more money, but the government doesn't know whether the extra cash has actually translated into better access for patients, a provincial watchdog revealed Monday.

While more Ontario residents now have a family doctor, that doesn't mean they have better access to their physician, said auditor general Jim McCarter.

McCarter reached the conclusion after looking at the province's alternative funding arrangement for doctors in his annual report.

Alternate funding allows doctors to receive an annual fee to provide a specific list of services to patients who enrol with them, rather than being paid for each service they perform. More than 7,500 of Ontario's 12,000 doctors have signed up.

The government increased this type of funding to improve patient access to doctors, but a ministry survey showed about 60 per cent of patients still waited up to a week to see their doctor, McCarter found.

Some physicians collected a total of $123 million one year just for having patients enrolled, even though 22 per cent of them didn't come in for a visit. About half of those 1.9 million patients visited other doctors instead, who billed Ontario's public health plan.

What's troubling is that the government hasn't analyzed whether it's actually getting value for money, the auditor said.

The extra funding should result in shorter wait times, longer office hours and better access to doctors, McCarter said. But the government just doesn't know whether that's happening.

"The ministry had done virtually no work to determine whether we've paid this extra money out, but are we getting the benefits that we're supposed to be getting," he said.

The Ministry of Health and Long-Term Care said it had done the analysis, but when McCarter asked to take a look, they couldn't locate the information, he said.

It would have come in handy when the cash-strapped government -- which is trying to freeze public sector wages -- sits down with doctors to hammer out a new contract next year, he said.

"That's really information that you would want to have when you sit down across the table from the OMA (Ontario Medical Association)," McCarter said. "(But) they just don't know."

He also found that the government actually paid some doctors to tell them how much money they were getting. The ministry paid 234 northern specialists $15,000 each to collect information on their income from all provincial government-funded sources.

It's "disconcerting" that the government doesn't know whether it's getting the biggest bang for its health-care bucks, said NDP Leader Andrea Horwath.

"It's the same kind of pattern as we saw with green energy," she said. "Which is you come up with these plans and you shove them out the door, but you don't have a good understanding of what it is you're looking for and make sure you're achieving it."

But that doesn't mean alternative funding for doctors is a bad idea, said Progressive Conservative Leader Tim Hudak. It has proven useful in encouraging doctors to move to remote and under-serviced areas, for example.

"But I think this gives us evidence to take a good, hard look at the program, that maybe you need something in between that ensures for all the money that we're spending, patients are actually seeing their doctors more promptly than they are today," he said.

Alternate funding is a "relatively new model" and it's too early to tell what impact it has on health outcomes, said Health Minister Deb Matthews.

"I know that the physicians I talk to want us to get best value for the money we're spending in health care, so this will all be part of a conversation," she said.

In 2007, most of the family physicians getting alternative funding were paid at least 25 per cent more than their fee-for-service counterparts. But the government hasn't tracked the full costs since then, according to the auditor's report.

The ministry also has trouble monitoring pay for specialists, the report said.

That's largely because the system is too complex, the report found. Specialists who provide academic services at teaching hospitals can receive up to 14 different categories of payments, for example.

Specialists used to be paid on a fee-for-service basis, but the government introduced alternative funding in the 1990s to encourage these doctors to do more training and research and to relocate to under-serviced areas.

The alternate payments have increased more than 30 per cent since 2006, but the government has done little formal analysis to determine whether alternate funding has improved patient access to specialists, McCarter found.

His report found other areas where the government may not be getting value for its health-care dollars.

For example, payments to emergency department doctors increased 40 per cent between 2006 and 2010, even though the number of patient visits rose only seven per cent.