Incentives for the Doctor’s Patients
In a proposal contained in a letter of understanding between the Ontario Medical Association. and the Minister of Health, George Smitherman, an agreement was reached that if doctors could lower the cost of prescribed medicine in the Ontario Drug Benefit Program by two hundred million dollars, fifty million would be made available for extra physicians’ services. Since the plan serves the elderly and welfare recipients, doctors themselves have stated that these people would suffer.
Another plan in the works would involve primary care physicians working in teams with other professionals such as nurses, nurse practitioners and other doctors on a modified salary basis. Patients would sign up with a group of physicians who would treat them on a flat-fee for a year`s service. Both these plans are flawed because in each case the benefit to the doctor is negligible.
In my experience as a practicing pharmacist I found that there is no better motivator than self- interest,ideally enlightened . No segment of Canadian society is really interested in saving money on health care. The politicians do not want to upset the public and the doctors by modifying the system and neither the patient nor the doctor has a real incentive to do so .
When I opened a drug store in Sudbury in the early 60’s it was my policy to call every doctor and strongly encourage them to use the generic equivalents of their written prescriptions. We, as pharmacists, made more money and the patient saved money. A lot of money! This worked for a few years until the United Steel Workers Union in Sudbury negotiated a drug plan for the miners in Inco. You can guess what happened! Many of our former satisfied customers came in demanding the brand-name drugs. And why not? They were not paying for the medicine themselves, so why not use the expensive brands.
The public has come to expect most aspects of health care to be free. In the last fifty years with all the high-priced technology, tests and drugs coming on the market and with seniors forming an ever growing percentage of the population, we are headed for a bankrupt medical care system unless we find creative ways to save money.
The patient must be given an incentive to save money.The incentive would look like this.. The Ontario government calculates how much money it pays out for each patient in the province and informs them by letter how much was spent on them in the last year. They are then told that if they can cut that amount by an arranged percentage, they will receive part of that saving for their own personal use. The system would be applicable only to adults so that parents could not make money by denying their children medical care. Patients would become more vigilant over physicians who try to build up their revenue by frivolously booking appointments ,as the patient will see this as a financial loss for them. Today many physicians expect an office visit in order to get a prescription repeated. In many cases this is a means to increase revenue for the doctor with little or no benefit to the patient. Patients would first ask for the less expensive methods of treatment in order to save money,so long as they felt comfortable that the treatment would work.
Critics of this system will say that the people will deny themselves medical care in order to get the money at the end of the year. Adults have to maintain responsibility for themselves and if there is flagrant abuse of the system by a particular patient in order to make money, a physician would be allowed to write to the health department, confidentially, that his or her patient is not getting the proper care.
If nurse practitioners and pharmacists were trained and allowed to see patients for minor medical problems at a lower fee than doctors, patients, might actually be inclined to use them. To further discourage the patient from frivolous use of medical care, a small user fee of two or three dollars would not bring any hardship to the majority of people.
In addition to saving money ,one of the positive byproducts of this incentive system would be that it would encourage people to become more informed and educated consumers of health care. Also patients would have an incentive to scrutinize health care expenditures made on their behalf and use medical care only when necessary.
