Commission on the Reform of Ontario's Public Services

Chapter 5: Health
Recommendation 5-60: Aggressively negotiate with the Ontario Medical Association for the
next agreement.
The government must be very strategic in its objectives to ensure the promotion of a highquality
care system that runs efficiently. Since Ontario’s doctors are now the best paid in the
country, it is reasonable to set a goal of allowing no increase in total compensation. However,
the negotiations must go well beyond compensation. They must also address the integration of
physicians into the rest of the health care system and the objective of working towards the
best possible health quality regime.
Recommendation 5-61: Adjust fee schedules in a timely manner to reflect technological
improvements, with the savings going to the bottom line of less expenditure on health care.
Technological improvements often reduce the time required for procedures. Will Falk has
recently pointed to the example of radiology, where government investments, including those
made through the Canada Health Infoway program, have resulted in vast productivity
improvements. Despite the fact that these improvements have drastically reduced the time it
takes to diagnose (and hence greatly increased the volumes of diagnoses that can be made in
any given day), the fee schedule has not been adjusted to reflect these effects. 64
Recommendation 5-62: Make Family Health Teams (FHTs) the norm for primary care and
design the incentive structure of physicians’ compensation to encourage this development.
Among the key characteristics of FHTs are the following:
� The regional health authority should play a key role in determining their relationship with
the rest of the health care system and setting ground rules for their operation;
� Make outcomes the focus of FHTs, not health interventions. Their operation should be
tightened through objectives, accountability and a data collection system;
� Conduct research to determine the optimal size of FHTs, taking into account factors such
as geography and patient demography. Balancing economies of scale while maintaining
personal connections between health care providers and patients is crucial: FHTs need the
scale to support a wide range of care providers and be able to support the administration
necessary, including the responsibility of tracking people through the system. It has been
suggested to the <strong>Commission</strong> that the optimal size, for larger communities, may be in the
range of 8 to 15 physicians, and include practitioners with a wider range of specialties than
is now the case. They now typically have only three to eight physicians; and
64 W. Falk, M. Mendelsohn, J. Hjartarson and A. Southey, “Fiscal Sustainability and the Transformation of Canada’s Healthcare System:
A Shifting Gears Report,” 2011, Mowat Centre, p. 36.
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