Let public see MDs’ billings
They’re willing to take public money — more than $11 billion a year — but Ontario doctors don’t want people knowing what any of them receives courtesy of taxpayers. According to physicians, the public just wouldn’t understand. They should give Ontarians a bit more credit. With just one doctor charging the health-care system a staggering $6.6 million last year, there’s a “compelling public interest” in knowing the identity of Ontario’s biggest billers, their medical specialty and how much each receives from the public.
That was the verdict of the province’s privacy watchdog last month. John Higgins, an adjudicator with the Office of the Information and Privacy Commissioner, ruled explicitly in favour of transparency and accountability. He quite rightly ordered disclosure of the name, specialty and Ontario Health Insurance Plan revenues of the province’s top 100 billers.
In a response as predictable as it was unfortunate, the Ontario Medical Association has moved to overturn that landmark decision. As reported by the Star’s Theresa Boyle, the organization representing 29,000 physicians, a group of about 40 doctors, plus one physician acting alone, have all filed for a judicial review of Higgins’ ruling.
According to OMA president Dr. Virginia Walley, the public should not be allowed to see what individual doctors receive because “OHIP billings will be misconstrued.” It is important to note that raw billings are not the same as a doctor’s net income. They don’t reflect a physician’s expenses, including the cost of running an office, paying staff and buying pricey medical gear. OHIP revenue also doesn’t capture the full “complexity of care” a doctor may provide.
According to the OMA, such subtleties trump taxpayers’ right to know who they’re paying, and how much, for providing a public service.
One problem with this argument is that the technicalities associated with assessing a doctor’s net income aren’t all that difficult to explain or understand. Furthermore, it’s entirely in order to request some clarification when a physician’s billings seem out of step with the norm or appear excessive. By keeping people in the dark about their doctor bills, the OMA would deny patients the right to ask for, and hear, an explanation.
Higgins was right to push for openness. It’s the first, essential step in fixing problems.
Regarding OHIP money paid to doctors, “it is an inescapable fact that these payments consume a substantial amount of the Ontario government’s budget,” Higgins said in a written ruling in June. “The concept of transparency, and in particular, the closely related goal of accountability, requires the identification of parties who receive substantial payments from the public purse.”
His finding is now being challenged by physicians who have filed applications with Ontario’s divisional court. But doctors would do better to recognize and accept the broad social benefit that flows from increased accountability.
Higgins’ decision came in response to a freedom of information request filed by the Star two years ago seeking data on Ontario’s top 100 OHIP billers. The health ministry revealed amounts being billed but refused to identify the physicians involved. The matter was appealed to the privacy commission, where Higgins ruled in favour of disclosure.
That decision should be allowed to stand. Revealing what doctors are paid through OHIP isn’t an unwarranted invasion of privacy or a rude intrusion into the lives of the affluent. It’s about providing taxpayers who fund this province’s health-care budget more information about where their money goes.
That could ultimately produce a better, more efficient system for doctors and the public alike.
What a doctor bills shouldn’t be kept secret