An article for physicians by physicians
Originally published September 2010
Medical liability protection is fundamental to the practice of medicine and is one of the key reasons physicians are able to confidently provide care to their patients. Respondents to the CMPA 2009 membership survey reaffirmed the importance of cost-effective medical liability protection when they overwhelmingly stated how vital this element of the CMPA's service offering is to their practice.
Canada's approach to medical liability protection is unique. As a result of negotiated arrangements, most physicians are reimbursed for all or a portion of their medical liability protection costs. This approach, through which governments directly acknowledge the inherent value of, and need for, cost-effective liability protection, has benefited Canadians since being introduced more than 20 years ago. The medical liability protection program promotes physician retention and continuous delivery of needed medical services, and ensures appropriate compensation for patients harmed as a result of negligent medical care.
Creating a fee reimbursement program
The origin of today's fee reimbursement program dates back to the middle of the 1980s when the CMPA began introducing changes to its membership fee structure. In keeping with its goal of equitably sharing risk, the Association, over the years, replaced its single fee model with rates that grew or shrank in proportion to the risks inherent in each member's type of medical practice, and to any regional differences in medico-legal costs. As a result of these changes, some CMPA members saw their annual membership fees decline; others saw their fees rise.
The provincial and territorial medical associations and federations—the organizations responsible for negotiating physicians' remuneration with provincial and territorial governments—developed an immediate response to the CMPA's amended membership fee structure. They successfully advanced that medical liability costs should be separated from physicians' regular clinical fees and paid for by the provinces and territories. In so doing, they negotiated that reimbursement be provided in lieu of other forms of remuneration.
This fundamental change proved successful on three fronts. First, by incorporating medical liability protection costs into broader remuneration packages, Canada's provincial and territorial governments confirmed the critical role of liability protection in supporting the practice of medicine. Second, physicians can continue to care for their patients knowing they will not be driven out of practice by rising medical liability costs. The confidence Canadian physicians hold is in stark contrast to other countries where skyrocketing costs have led physicians to cease or limit their practice, robbing them of their livelihood and their patients of access to care. Finally, the stability afforded by the fee reimbursement programs benefits patients by ensuring there is compensation for those harmed as a result of negligent medical care.
A valuable program, in every province and territory
Since the first model was launched in the 1980s, fee reimbursement programs have evolved and been extended to all Canadian provinces and territories. Every medical association or federation now shares a reimbursement agreement with its respective provincial and territorial government.
While the details differ, the value of reimbursement transcends provincial and territorial borders. As medicine becomes more complex, physicians need to be able to count on stable programs that accommodate their liability protection needs. The fee reimbursement program is an important element of that safety environment, enabling physicians to practise confidently and with peace of mind.
Patients are important beneficiaries of the stability engendered by the medical liability protection program. Qualified physicians are in demand around the world. In this highly-competitive environment for skilled medical personnel, fee reimbursement programs contribute to physician retention—benefiting patients across the country.
The CMPA is committed to the fee reimbursement programs
Although the CMPA does not negotiate fee reimbursement programs, it has an important role to play in ensuring that its membership fees are sustainable over the long term. The CMPA is committed to collecting, in a stable and predictable manner, only those funds necessary to meet members' expected liabilities.
Fee reimbursement programs are one of the crucial, often under-appreciated, features of Canada's medical liability system.