In theory, we in Ontario have a health care system that is the envy of the world. It is mostly supported by our taxes. We do not pay premiums, and it has the potential to provide us with the basics of what we require. We need to remember that OHIP stands for Ontario Health INSURANCE Plan, and it is insurance like no other. It is NOT FREE, and it certainly falls far short of covering everything. It has been in existence for over 30 years, and in that time the rules have been modified and changed to produce efficiencies. These same changes over time have resulted in a complex maze of exceptions, exemptions and confusion. No one, including the thousands of people who work in it, truly understands it anymore. Until recently, this public insurance company had its own set of audit laws, acting as judge and jury and could fine medical practices at will. That is, until this faceless, nameless, vigilante-like behavior drove one of my colleagues to take his own life. Dr. Anthony Hsu was a pediatrician in the autumn of his career. No one ever disputed that he was well qualified, and worked 70-hour weeks in an underserviced area. His so-called "OHIP crime" was to concentrate on patient care and keep less than perfect notes. What's more, he often underbilled or forgot to bill for minor services. "OHIP" unbelievably had the power to unilaterally demand and take his RRSP savings of over $100,000. There were no trials or hearings and no one needed to ask for an explanation. Those responsible were able to remain nameless behind a large bureaucracy. Despondent over this gratitude from an agency representing the same people to whom he devoted a lifetime of selfless service, Dr. Hsu's lifeless body was later discovered in the lake. The Niagara peninsula was in total shock. The resulting anger brewing amongst his friends, family, patients and colleagues soon caught the attention of incoming Health Minister George Smitherman. The Hon. Minister appointed Supreme Court Justice Peter Cory to review the system. His recently completed review made over 118 recommendations, calling for extensive changes to the audit system, and abolishing the OHIP general manager's ability to recover funds without due process.
On the one hand, up to 30% of the primary care provided by physicians goes largely unremunerated, because it is difficult to fit it into the complex rule scheme of OHIP insurance, yet it is performed for patients mainly out of altruism. On the other hand, most physicians also feel that OHIP rates undervalue their work. This notion is supported by the Ontario Medical Association which publishes an annual fee schedule that almost doubles the OHIP rates, and reflects a comparable level of remuneration within North America. The $27 charge for a consultation with a health care provider, which includes all overhead charges, is a bargain. No other professional services are comparable. It almost belittles the meaning of a professional. You can imagine that reflex anger that brews inside when service bills are questioned. What I really wonder is whether the new Family Health Team Model introduced as a pilot project in a few choice locations around the province will evolve to overcome these basic inefficiencies? The media hype seems to imply that it will, but I fail to see where all the free work will be download to?
● Medical Audit Practice Initiative (Ontario) - Honourable Peter deC. Cory's Final Report to the Minister, 21 Apr. 2005, Submissions from Institutions and Organizations, Submissions from Individuals (including Mrs. Irene Hsu, Submission with attachments in PDF, and Oral Submission in PDF), Medical Audit Practice in Other Provinces, Decisions of the Health Services Appeal and Review Board on appeal from the Medical Review Committee, and Room Index.
● Blog on Judge Cory's Commission on the Physician Audit System from Medical Doctors and Natural Health, 2 Nov. 2004.
● Audits leave Ont. doctors bankrupt, demoralized by Avis Favaro, CTV Medical Specialist, 14 Nov. 2002.