Fee setting in Canada: controversy and solutions

Abstract

No province in Canada has implemented an RVG, although both Alberta and British Columbia are in the final stages. Many complications exist. There is concern that those sections within the medical association that feel they will be financially disadvantaged will attempt to prevent the implementation of the RVG. They may persuade the board of directors not to implement or perhaps to phase in the implementation so that they have time to adjust to lower revenues. Even with simulations being done to establish the potential impact on sections, there is no model that can predict what behavioral changes may take place after the RVG is implemented. With the medical associations controlling the fee, governments must be assured that medical services will be delivered in the same manner in which they were delivered before the RVG and the global budget were instituted. An analysis of the changes and their causes is an important aspect of the process. Factoring out the relationships will be challenging.