"Seldom, very seldom, does complete truth belong to any human disclosure; seldom can it happen that something is not a little disguised, or a little mistaken." - Jane Austen
Recently, the Toronto Star has been involved in an ongoing and well-publicized (by them, anyway) attempt to disclose the names of the top 100 physician billers to Ontario's Health Insurance Plan (OHIP). According to them, they have been attempting to get this information for over two years.
In an editorial condemning the Ontario Medical Association (OMA) for seeking a judicial overturn of the recent Privacy Commissioners ruling that the names of the top 100 billers be revealed, the Star listed a variety of reasons that this information be public ranging from entirely reasonable to bizarre.
Look, I completely agree with the Star when they say that there should be more openness and transparency when it comes to physicians' billings, as most physicians are paid from the public purse and transparency will lead to more accountability. Frankly, this might even benefit physicians, as I suspect many people will be shocked at how little some physicians make in comparison to say, hospital CEOs or even executives from eHealth Ontario.
However, the Star then veers off the deep end by asserting that publishing the names of the top 100 billers on Ontario's salary disclosure document (a.k.a. the Sunshine List) would "deny patients the right to ask for, and hear, an explanation."
Really?
Say you have a high fever, are coughing up purulent phlegm, wracked with muscle pain. Are you honestly going to go to your doctor, get checked up, and then say, "Hey, instead of me letting you treat the other sick patients in your waiting room, let's spend some time talking about why you billed $X to the health care system?"
British Columbia has been revealing physicians' billings for years, and it hasn't stopped any of the problems they have in their health system from accumulating.
Further, the Star asserts that this "could ultimately produce a better, more efficient system for doctors and the public alike." Except that there is absolutely no evidence that revealing billings will improve the health care system.
Has revealing the salaries of eHealth executives improved health care information technology in any way, shape or form? Did it prevent CCAC (whose executives have been on the Sunshine List for years) from becoming a disaster? Has it helped the useless Local Health Integration Networks from being less useless?
As one of my colleagues pointed out, British Columbia has been revealing physicians' billings for years, and it hasn't stopped any of the problems they have in their health system from accumulating.
Look: it's extremely important for government finances and expenditures to be transparent for the general public, who, after all, foot the bill. The problem however, is that the Sunshine List is anything but fully transparent, and needs to be fixed before revealing physicians' billings.
For example, let's take the case of the disastrous (according to health care leaders!) Deputy Health Minister Bob Bell. His salary is $426,535 with a listed "benefits" of $753. The problem is that the benefits number is wholly unbelievable.
Article after article after article on the value of a benefits package puts the real value of a compensation package at between 20 to 30 per cent of the salary, which is an added cost to the employer. Guess who Bob Bell's employer is? Why, it's YOU the taxpayer, and you are actually paying more than what's listed on the Sunshine List to keep him in his job.
Similarly, from a family physician's standpoint, currently about 40 per cent of billings goes towards overhead. The Ministry of Health likes to quote 30 per cent, but that ignores the requirements to register with professional colleges and for the Continuing Medical Education courses that are mandatory. This needs to be reflected in the Sunshine List.
Putting this all together then, the Sunshine List would look something like this: for Bob Bell, it would say salary of $426,535, plus value of benefits (say 25 per cent) of $106,633.75. That would equal the total value of the package Bob Bell receives, or $533,168.75.
For a family physician billing $320,000, the list would show $320,000, less the 40 per cent average overhead ($128,000), to arrive at the overall value of the physician: $192,000. Yes, that's still good money, and we're fortunate to make that -- but it's NOT $320,000, either.
A similar process would be used for physicians in different specialties. For example, there are many radiologists whose overhead approaches 75 per cent because they own and service their own diagnostic equipment and that number should be used for them, instead of the 40 per cent number used for family physicians.
As mentioned previously, none of this disclosure will actually help improve health care. We have to drastically reduce the bureaucracy in health care first. However, it would provide a much more accurate, appropriate and modernized version of where your tax dollars go. This kind of transparency is important in a democracy.
So, let's get on with it -- and fix the Sunshine List.
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