Physician Fee Schedules: Canada

Canada Dept: Physician spending was highlighted as one of the fastest-growing public-sector health categories of recent years, with half of the growth attributable to increases in physician fee schedules. Economists are not surprised that physicians have been able to negotiate generous fee increases given the period of physician shortages. However, it should be noted that the period since 2003 has seen a rebound in the number of physicians due to higher medical-school enrollment and the immigration of international medical graduates, according to Winnipeg Free Press. One of the arguments used to restrict medical-school admissions in Canada in the early 1990s was that physicians were a primary cost driver in the health system because of their role as gatekeepers. Reduce the number of physicians and replace them with nurse-practitioner teams and it was felt cost savings would automatically ensue. The result was a physician shortage. Moreover, after a short pause, health-care spending continued to mount, driven by drugs, diagnostic technology and public-health initiatives. The recent increase in physician numbers makes up for the reductions of the 1990s but has also been fueling expenditure increases and the recent release of National Health Expenditure Trends by the Canadian Institute for Health Information puts total health expenditure in Canada at $192.9 billion in 2010 and $200.5 billion in 2011 -- annual increases of 5.9 and four per cent respectively. This year's release was also accompanied by a report titled Health Care Cost Drivers: The Facts, which finds the period from 1998 to 2008 was one in which public health care spending grew at an average of 7.4 per cent annually -- double the rate of government revenue. Governments are often conflicted when it comes to public health care. While more physicians means more services and access for the public, it also means more public spending. With health care sustainability once again moving into the forefront of policy discussion in Canada, physicians and their role as health-system gatekeepers will be coming under scrutiny. Indeed the cost and effectiveness of many procedures will likely be an area of examination. (www.immigrantscanada.com). As reported in the news.