An analysis of alternative funding for physicians practicing gynecologic oncology in Ontario, Canada prior to 2001.
OBJECTIVE
To consider the policy issue of physician reimbursement by examining the events that preceded the Ontario Gynecologic Oncologists moving from a fee-for-service environment to an alternate payment plan in 2001.


METHODS
The sources of information included a literature search, reviewing Canadian newspapers, interactions with key leaders in the field (Ontario Medication Association, University physicians), and meeting minutes from both university and provincial groups considering alternate payment plans.


RESULTS
The problem for Ontario Gynecologic Oncologists involved the goal of providing excellent clinical care, undergraduate and postgraduate education, research and administration in the midst of problems with recruitment, retention and remuneration. Multiple causes for this problem included limitations in health care spending and a fee for service payment schedule that did not adequately reimburse complex care. This funding problem got on the agenda as a result of a front page article in the national newspaper and letters of concern solicited from local members of the provincial parliament. The policy formulation needed to account for alternate financial options and the roles of institutional structures such as the universities, Cancer Care Ontario and the Ontario University Health Science Centers. The influences on the evolution of the new funding policy included the actors, their interests, their values, research on the topic and institutions.


CONCLUSIONS
The tensions between the goal of excellence in care, education, research and administration and difficulties with recruitment, retention and reimbursement, led the Ontario Gynecologic Oncologists to seek an alternate mechanism of reimbursement from the fee-for-service model.
Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada.
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Elit
D000328:Adult; D000368:Aged; D018588:Fee-for-Service Plans; D005260:Female; D005376:Financial Management; D005378:Financial Support; D006176:Gynecology / Q000191:economics* / Q000592:standards; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics* / Q000592:standards; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012307:Risk Factors