Now doctors are typically paid on a fee-for-service basis. Surgeries and other treatments are paid from hospitals’ global budgets. This has it exactly backwards
Oh, by the way, the government of Ontario has just turned the province’s health-care system upside down — the most sweeping reform to health care, as it has been described, in 50 years. Only nobody quite knows what’s involved, least of all, it appears, the government.
Whether either of these reforms will work as intended however, will depend crucially on the details. So far, what we have is mostly a lot of buzzwords about being “connected” and “sustainable,” “patient-centred” and “digital-first.” Still, that only gets you so far. Some decisions on health care need to be made centrally, but most do not. It’s not clear the Ford government gets this. Much of the accompanying rhetoric, indeed, gives the impression that what the government thinks Ontario’s health care system needs is more and better central planning — when in fact central planning is the problem.
Enter the new Ontario Health Teams. Again, much remains to be explained, or possibly worked out. How would these be formed? Government orders? Spontaneous attraction? Random chance? How would patients be enrolled? Just on the basis of where they lived, or could they choose from competing teams? It does so because, for the most part, nobody knows what anything costs. We do not have information on costs, because nobody has the incentive to collect it. That won’t change until we change the way the system is funded — not the public funding at its source, but the way in which those funds flow through the system: the way people get paid, to be vulgar about it.
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