Maintaining equity in membership fees
Since the CMPA’s founding in 1901, the costs of medical liability protection have been shared among its physician members. The CMPA has a long history of evolving its approach to how member fees are set to reflect changes in the medical liability environment and member needs. For example, when faced with rising protection costs in the 1980s, the Association adopted a “fully funded” model which was aimed at holding at least one dollar of assets for each dollar of discounted liability. The CMPA has largely maintained this status.
When faced with similar upward pressure in protection costs in 2000, the Association worked with provincial and territorial medical associations and federations to create a regional fee model in which members paid fees based on their practice in one of three fee regions: Ontario, Québec, and the Rest of Canada. The regional model reflected the different costs of protection in each region and sought, within the concept of mutuality, to apportion costs to members in an equitable manner.
The regional model introduced in 2000 served the CMPA and its members well but it now requires adjustment to reflect the increasingly divergent cost trends within the Rest of Canada region. After detailed analysis and cost attribution, starting with the 2016 membership year the Rest of Canada fee region has been subdivided into two new regions:
- British Columbia and Alberta
- Saskatchewan, Manitoba, the Atlantic provinces, and the Territories
This updated regional structure is another example of the CMPA adapting to changing circumstances and reflects our ongoing commitment to member equity.
While these adjustments support fairness in the fees paid by members, they do not address the continuing increases in the overall cost of providing medical liability protection. In 2014 innovative solutions with legal firms resulted in the CMPA reducing its legal expenditures by over $10 million from 2013, and doing so without affecting the quality of services provided to members. And by continuing to leverage technology, we have also reduced our operational expenditures while experiencing growth in membership.
The CMPA’s single largest cost component is compensation to injured patients and we continue to see payment increases that are far greater than the rate of inflation. In 2014 the CMPA paid, on its members’ behalf, $237 million in compensation — the second highest on record. The increase is most pronounced in Ontario where median compensation has increased 151% in the past decade.
As a result of these trends and after making adjustments for the estimated financial position of each of the four fee regions, the CMPA has established aggregate fees for each region as follows:
- British Columbia and Alberta: $156.3 million (10% increase from 2015)
- Ontario: $377.2 million (33% increase from 2015)
- Québec: $80.8 million (3% increase from 2015)
- Saskatchewan, Manitoba, the Atlantic provinces, and the Territories: $46.5 million (39% decrease from 2015)
The regional allocation of protection costs is further apportioned based on members’ type of clinical practice. Members with clinical practices that have higher medical liability risk (e.g. obstetrics) pay a proportionate share of the costs. The fee for each type of work is shown in the fee schedule which can be found on the CMPA website.
Effective and efficient medical liability protection enables Canadian physicians to practise medicine with confidence and in the knowledge that their interests and those of their patients are protected. While the Canadian medical liability system is the best in the world, it is being threatened by rising protection costs. The CMPA is actively engaged with provincial and territorial governments and other stakeholders to encourage sensible reforms to contain costs — but we cannot do this alone. Physicians have a responsibility to practise as safely as possible, reducing the harm caused to patients. And governments should undertake appropriate system adjustments to reduce unnecessary costs that lead to increases in expenses related to liability protection.
We know that, with the CMPA’s assistance, the vast majority of physicians are doing their part to improve the safety of care. It is now time for governments to take the lead in reducing system inefficiencies.
Hartley Stern, MD, FRCSC, FACS