The process for getting a new deal with the 10,000 or so doctors paid through B.C.'s medical services plan will begin in the coming weeks, and the budget released Tuesday notes measure will be introduced to restrict the growth in those costs.
The budget is meant to serve as a shot across the bow for doctors. The government said it intends to clearly lay out its expectations as far as containing costs, and then negotiate with physicians about how to get there.
"The outcomes of negotiations that are expected to occur over the fiscal plan period will have to be consistent with the ministry budget," the budget documents said.
The government is looking for the savings for 2014-2015 and 2015-2016 and expects they will come from renegotiated fees for services. Some services doctors provide will no longer be paid for by government and some will garner lower fees.
The doctors will be notified about the beginning of negotiations March or April, but Dr. Shelley Ross, president of the B.C. Medical Association, said she doesn't expect the two sides to actually get down to talks until after the May election.
"I think it will be tough to make big speculation on what's going to happen," said Ross.
When asked if the talks with doctors could lead to a demand for a pay cut, Finance Minister Mike de Jong replied: "It is fair to say there will be an intensive negotiation."
The Ontario government reached a deal with its doctors late last year, but only after the Liberal government in that province was forced to back off a plan to cut fees for some services. The agreement was reached after negotiations over what fees to cut and where.
For example, the Ontario Medical Association agreed to perform fewer colonoscopies on healthy patients.
The B.C. government is hoping to use Ontario's collaborative approach and avoid the chaos caused by the Ontario government's earlier edict.
Ross noted the master agreement with doctors prevents the B.C. government from unilaterally imposing cuts.
Negotiations with B.C. doctors will be a key part of the province's efforts to further clamp down on health-care spending as it attempts to keep the budget in the black — a central promise as the governing Liberals head into the May provincial election campaign.
Keeping a short leash on health-care costs means the government will also be restricting laboratory and drug costs.
"It is in those kinds of areas that we will be looking at savings, because the transfers to health authorities for front-line services will remain consistent with the amounts set out in last year's fiscal plan," said de Jong.
The 2012-2013 budget notes health-care spending will increase by $2.4 billion over three years.
That's based on spending increases over the next three years of 2.6 per cent each, a drastic reduction from the spending increases of seven per cent between 2005 and the 2008-2009 budget year.
After that, spending dropped to an average of 4.4 per cent. The latest budget will cut that almost in half again.
De Jong denied suggestions the spending restrictions will lead to a drop in services.
"The thing about health care is you can always spend more money," he said.
"This notion that the only way to affect positive outcomes in health care is by spending more than anyone else, surely that's been proven over and over to be false."
The budget notes the money for health authorities to provide so-called "front-line" services to patients won't change from what was predicted in last year's budget.
The province also plans to save money by restricting laboratory costs.
"B.C. has the only uncapped fee-for-service outpatient laboratory funding model in Canada and there continues to be issues of duplication and redundancy," the budget said.
As well, the government has previously announced new drug pricing regulations, which will come into effect this year. They are aimed at reducing the price of generic drugs to 20 per cent of the brand name price, from the current 35 per cent.
And the budget said a "significant portion" of savings will be made through the so-called "patient-focused funding" scheme, which provides money to hospitals based on their ability to meet performance and budget targets.
In 2010, then-health minister Kevin Falcon announced the results of pilot projects introducing patient-focused funding, saying the model led to better management and better services, such as shorter wait times for breast cancer diagnosis and increased hip and knee replacements.
The budget said the 2013-2014 budget year will be the year the province moves towards making that the norm for deciding how much to allocate to health authorities.
Canadian Doctors for Medicare said the budget represents a "significant spending cut" to health care, noting the modest increase in spending would be outstripped by inflation and population growth.
"We can expect less increases in health spending in the future, but if we keep cutting the system now, we are at risk for increasing privatization, higher long-term costs and a more sustainable health system," said the group's Dr. Vanessa Brcic.
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