Given the province’s dire economic outlook, a local health economist expected the government to set a hard cap on health spending, rather than announce a series of commitments to collaborate with physicians.
On Wednesday, the province announced it had reached a tentative agreement with the Alberta Medical Association that would help slow the growth of health care spending and improve services for patients over the long-term.
The agreement set out a number of amendments to the existing master agreement for the period of 2011-2018, including the commitment to collaborate on a needs-based physician resource plan, new information technology and data-sharing for primary care facilities, and new compensation models.
“It seems to be reasonably positive,” said Richard Plain about the agreement, “but given the dire circumstances of the province of Alberta, in respect to its deficit, I would have thought that given the earning position of Alberta physicians and what has been happening in terms of compensation growth that we would have seen the government come up with a hard cap – meaning so many billions of dollars period.”
The tentative agreement comes on the heels of a report, issued Aug. 23, that showed Alberta doctors make $27,000 more than the national average and earn the highest incomes in the country.
The Canadian Institute for Health Information found that Alberta doctors made an average of more than $366,000 last year.
It also found that about 87 per cent of all clinical payments in Alberta, which amounted $3.1 billion last year (an 8.2 per cent increase over 2014), was done through fee-for-service – a payment made for each service provided by doctors.
Doctors’ income has been at the forefront of the talks between the province and AMA since they began in January.
The government’s goal is to move away from fee for service payment models to per patient models where it makes sense, said government spokesperson Cameron Traynor. The government is aiming to rein in annual health care spending increases to 1.8 per cent starting in 2018.
Wednesday’s announcement included a limited trial of a blended capitation model for primary care physicians and an improved academic alternative relationship plan for the universities of Calgary and Alberta.
The blended capitation model provides a base payment for each enrolled patient, as well as fee-for-service payments for non-enrolled patients.
According to Plain this model could improve the quality of health services by encouraging doctors to spend more time with patients who need it.
Plain was happy to see the proposal for a needs-based physician resource plan.
Alberta’s physician pool grew by 5.2 per cent, to 10,019 doctors, in 2014-15 alone. Given that most congregate in the province’s urban centres the influx of doctors doesn’t necessarily make our health care system more efficient, but certainly more expensive, said Plain.
Redistribution could also help on the better patient care side, but Plain is doubtful the proposed amendments will achieve the province’s cost control objectives.
The agreement is expected to slow the growth of health care spending by the end of 2018. Associate Health Minister Brandy Payne wouldn’t say by how much, as the government wants physicians to review the deal before those numbers are made public.
Health care costs have been rising at a rate of six per cent annually over the past 20 years.
Dr. Darryl Labuick, a family physician at the Grandin Medical Clinic, said the economic downturn has acted as a catalyst for a conversation surrounding efficiency and quality of care that Alberta doctors have been trying to have for a long time.
“It’s been really difficult to bring it to fruition,” he said. “We’re at a point right now that because of the cost savings measures that need to be looked at there’s more enthusiasm by government to look at these models.”
The agreement needs to be ratified by Alberta’s doctors. It will be presented to AMA members in the coming weeks. A vote is expected by mid-October.
The government and the AMA have also agreed to begin negotiations on the overall agreement, expiring in 2018. Talks were previously scheduled to begin in 2017.
