As the Canadian Medical Protective Association (CMPA) celebrates its 100th anniversary this year, it faces a couple of challenges.
First, the Quebec government is considering creating its own government-run medical malpractice program. In his final report as CMPA president, Dr. Bill Thomas said it is the association's “sincere wish” that Quebec doctors remain part of the national body, but the province “continues to explore” the creation of a separate organization. The threat has developed even though fees in Quebec dropped by more than 50% last year and will drop by a further 2% next year.
Second, a 3-year deal mitigating large increases in CMPA fees for Ontario doctors is now in its second year, and if awards and settlements awarded by the courts continue to increase another battle over fees looms in 2004.
For next year, however, the 60 000 members in the CMPA's 3 regions — Quebec, Ontario and the rest of Canada — will see few surprises. With their 2; decline, fees for Quebec members will average $1998 annually. For members outside of Quebec and Ontario, the average fee will be $3740, also 2% less than last year. In Ontario, the average “cost per member” is expected to be $5147, an increase of 8.3%. However, physicians in specialties such as neurosurgery, orthopedic surgery and obstetrics will face far higher costs due to their increased medicolegal risks. The actual CMPA fee schedule for 2002, based on region and type of practice, will be released this fall.
Ontario fees are higher because the province's courts award the largest damages. The 3-year deal signed last year was designed to phase in an approximate overall fee increase of 45% that was made necessary by the CMPA's move to regional rating. The deal, struck between the Ontario Medical Association, CMPA and provincial government, provided for significant subsidies for malpractice fees and eliminated the need for doctors to pay their fees up front. Instead, they can wait until they are reimbursed by the government.
The CMPA has set the aggregate fee requirement to cover all potential legal activity on behalf of its Ontario members at almost $117 million for 2002, a 12.5% increase.
Thomas said all 3 parties have agreed to seek ways to reduce the cost of settlements and court awards through tort reform and risk-management efforts. “These measures must be invoked quickly if a further medical malpractice crisis in Ontario in 2004 is to be averted,” he said.
Signature
Steve Wharry
CMAJ