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Targeting Health Care Costs:


James Rutka
James Rutka

As many of you know, the Ontario Medical Association (OMA) has been having difficulty this year reaching a negotiation for a new agreement with the government for the funding and delivery of medical services. The government faces significant fiscal challenges with the funding of health care. Cuts in the order of $1 billion for medical programs and services are being proposed over three years. These cuts may jeopardize gains we have come to appreciate and realize in reducing wait times for surgeries and obtaining important diagnostic tests in a timely manner.

I have had an opportunity to review some of the proposed cuts to the health care budget that affect surgical specialties in the province announced on May 7th, 2012. Across our Divisions and programs, the cuts vary from a low of -0.3% in the case of Plastic Surgery, to a high of -9.9% in Vascular Surgery. The specialties which may be affected the most by these cuts are Vascular Surgery, Neurosurgery (-5.3%) and General Surgery (-3.5%). For Vascular Surgery, the government has identified vascular ultrasound tests performed by vascular surgeons as an area of cutback; for Neurosurgery, it is the use of stereotaxis for craniotomy for tumour or vascular cases; and for General Surgery, colonoscopy and gastroscopy procedures are being targeted.

While at first glance some of these cutbacks do not seem aggressive or deleterious, for some surgeons whose practices rely heavily on earnings received from procedures that are being targeted, the situation is different. Lest you feel that surgeons are the only ones being affected by the Government’s actions, other specialties stand to be affected more. For example, the cuts initially proposed to Cardiology are the highest of all in the Province amounting to -13.8% for 2012-13. The Government has also identified Anaesthesia (-5.7%), Internal and Occupational Medicine (-5.6%), Ophthalmology (-11.4%), and Diagnostic Radiology (-6.4%) as in need of some targeted adjustments. In total, with these cutback measures that affect professional and technical fees, the Government hopes to trim some $340 million from its Health Care expenditures for 2012.

Interestingly, on July 4th, 2012, the government announced it would halt plans to halve the fees paid to doctors for certain diagnostic tests after cardiologists and others warned that the cut could hurt patients’ care. The 50% reduction in payments related to self-referral testing where cardiologists use their own equipment to perform exams such as echocardiograms and X-rays.

In the second week of July 2012, the OMA officially filed a Charter challenge against the government in the Ontario Supreme Court. The Court is being asked to reverse the unilateral fee cuts, to order the government back to the negotiations table, and to confirm the OMA’s representational rights on behalf of doctors in the province.

I do not think any of us would argue with the need to contain healthcare costs in the province which are currently estimated at almost 50% of the entire provincial budget, with annual expenditures of $46 billion. However, when the above cuts are implemented at precisely the same time that the Government is introducing Health Borders Allocation Methodology (HBAM) into Hospitals and moving away from global budget funding, the effects on surgical services at hospitals may be affected even more, creating a perfect storm.

I also think we agree that as surgeons we have done extremely well and have enjoyed an excellent quality of life with procedural tariff increases that have accrued to us these past several years. My advice is that we continue to work through and support the OMA in its negotiations with the Ministry of Health. We should charge our specialty specific OMA representatives to be at the tables through the negotiation processes so that our voices are heard. The best outcome, in my opinion, would be if the government and the OMA could come back to the table again to negotiate in good faith, and to rationally and equitably suggest cuts that will accomplish what the government has stated is necessary. I will be discussing these and other matters with the Department Chairs in Surgery across the province. I will keep you informed of any further developments as the dialogue continues.

James T Rutka,
RS McLaughlin Professor and Chair

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