Primary Care Physician Compensation Reform: A Path for Implementation
The recent report by Alberta’s Blue ribbon panel on the province’s finances denounced Alberta’s Fee-for-Service (FFS) model as a significant source of inefficiency and cost within the health system, going as far as to suggest legislating a non-FFS model. If pursued, Alberta would be the first province since the start of Canadian Medicare to fully shift away from FFS. There has already been considerable study and debate on which FFS alternative is most appropriate in different care settings, but little discussion has been generated on the best practices for implementing such a reform. This paper explores physician compensation reform work for physicians, patients and government alike, focusing on compensation of primary care physicians. Since the early 2000s, family physician costs in Alberta have significantly outpaced specialist costs, which has drawn attention to reconsidering compensation models for primary care specifically.
Alberta has two options beyond the FFS-dominant status quo to consider: (1) legislate in an alternative payment plan (APP) to replace FFS, or (2) phase out FFS by implementing policies that make APP a progressively more attractive option for primary care physicians. This paper provides a scan of emerging practice and evidence from across Canada. The practical and political lessons learned point to the need for a systematic phase-out of the FFS payment model in primary care. However, there is no evidence to suggest that legislating in a mandatory replacement of FFS is the optimal way forward. Experience across the country demonstrates that physicians when presented with a viable alternative to FFS will uptake, but for that alternative to be viable the status quo must not retain the upper-hand.
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