Physician Funding Models

FUNDING OF PHYSICIANS

As mentioned, physicians are funded through four funding models.

Fee-For Service (2011/12 - $3B)

Fee-for-service refers to payments provided to physicians per service provided. Each service or fee item has a separate code, which is used by physicians to bill MSP for the service provided.

Alternative Payment Program (APP) (2011/12 - $410M)

The Ministry of Health’s Alternative Payment Program (APP) provides funding for the payment of contracted service, sessional and salaried physicians where an alternative to fee-for-service funding is needed to maintain, stabilize or improve patients’ access to medically necessary physician services. An APP arrangement can be used to fund:

  • part-time physician work,
  • practices where the volume of services provided would not provide service stability or dependable physician income, and
  • contracted physicians’ management of complex or time-consuming patient care by allowing them to bill for the actual amount of time spent with or on behalf of patients, instead of the number and type of services.

Examples of types of clinical programs funded by APP are psychiatry, oncology, addictions treatment, emergency rooms and primary care.

Medical On Call Availability Program (MOCAP) (2011/12 - $130M)

This program was created to meet the medical needs of new and unassigned patients requiring emergency care. By definition, a new or unassigned patient is not a patient of any physician participating in the call group. The health authorities are responsible for managing MOCAP funds and they use the available funding to contract with physicians to provide emergency on-call services. The health authorities have contracts with physician call groups to provide specified coverage, and are provided payment in accordance with the MOCAP policies.

Rural Funding (2011/12 - $50M)

The Ministry currently funds nine rural programs focused on recruiting and/or maintaining physicians in rural practice.

  1. Rural Retention Program - established to enhance the supply and stability of physician services through payment of annual retention benefits to eligible physicians.
  2. Rural General Practitioner Locum Program - enables eligible general practitioners to have reasonable periods of leave from their practices for continuing medical education, maternity leave, vacation and health needs.
  3. Rural Specialist Locum Program - enables specialists in certain rural communities to have periods of leave from their practices for continuing medical education, maternity leave, vacation and health needs.
  4. Rural Continuing Medical Education - makes funds available to eligible physicians to assist with eligible educational expenses.
  5. Rural Education Action Plan - provides funds to support and facilitate the training of physicians in rural practice and undergraduate medical students and postgraduate residents with rural practice experience.
  6. Recruitment Incentive Fund - makes financial benefits available to eligible physicians to fill vacancies identified or pending vacancies.
  7. Recruitment Contingency Fund - makes payments available to health authorities to assist in the recruitment of physicians to rural communities where failure to do so would have a significant impact on the delivery of medical care.
  8. Northern and Isolation Travel Assistance Outreach Program - funds approved physicians for approved travel to certain communities for providing medical services.
  9. Isolation Allowance Fund - makes payments available to physicians providing services in areas where there are fewer than four physicians and no hospital.