It seems fair to view this as a significant improvement over the unilateralism of the last two years (and the prospect of several more years of unilateral government action in the absence of an agreement). The agreement provides for a binding third party decision if the OMA and government cannot reach agreement on the measures to be taken if the budget is exceeded, or on modernization changes to the schedule of benefits. Moreover, with respect to at least some issues, the OMA has achieved a binding process of arbitration (even though the agreement does not use those terms).
As a result, the OMA will continue to have the right to pursue its argument in the courts that physicians are constitutionally entitled to a process of binding arbitration. This is because the new agreement preserves the OMA’s right to continue its court case seeking binding arbitration. With respect to binding arbitration, while the new agreement does not achieve binding arbitration on a go forward basis, it also does not abandon the OMA’s claim that physicians are constitutionally entitled to binding arbitration, leaving the issue very much alive. However, there is another, perhaps more pragmatic perspective, which may be more closely attuned to the actual text of the tentative agreement and to the history of OMA/Government negotiations since the early 1990s. Obviously, these concerns have resonance with some segments of the medical profession. The tentative agreement accepts a hard cap on the physician services budget which will result in under funding of patient care and downloading of fiscal responsibility for health care onto doctors.The OMA has abandoned its core promise that it would not reach a new agreement without securing binding arbitration and.The financial details notwithstanding, and stripped of their somewhat overblown rhetoric, those opposed to the tentative agreement raise two primary concerns: the dollars saved can in turn be used for other unaffected physician services. In addition, it commits both parties to find $100 million in permanent reductions to fees or physician payments in each of 2017-20, with the government in turn committing that the savings resulting from those changes will not reduce the guaranteed 2.5% annual increases to the maximum physician service expenditure budget, i.e. In terms of its financial terms only, while the tentative agreement leaves in place the previous 2015 across the board discounts and targeted fee cuts, it also guarantees a 2.5% annual increases to the physician services budget over each of the next four years, with the possibility of additional one-time only payments adding up to $370 million over the four years of the agreement. Given the unusually contentious nature of the response to the tentative agreement, what is one to make of the merits of the new deal? Or do they vote against the agreement, in the hope that court action will eventually result in binding arbitration (something that – as I have pointed out in an earlier post – will likely take years to litigate and whose outcome is far from certain), or because they believe that the profession or elements within it will be willing to engage in job action to resist further unilateral government measures and achieve greater gains and protection than those set out in the tentative agreement?
Do they vote in support of the tentative physician services agreement, concluding that relative to the risk of further adverse unilateral government action in the absence of an agreement, the deal contains a larger measure of stability, a greater degree of financial protection, and a formal role for the OMA in co-management of the physician services budget? When they meet on August 14, Ontario doctors will have a significant choice to make.
0 kommentar(er)
