Doctors and Canadian Medicare: Improving System Performance Requires System Change.

Many of the issues raised and insights provided by Marchildon and Sherar (2018) in their essay on doctors and Canadian medicare are on target. The inadequacy of available data on physician payment, however, calls into question the robustness of some interprovincial comparisons, and when it comes to compensation, comparisons to US physicians would be most relevant. In contrast to their assertion of a steadily increasing growth rate in physician expenditure, a more recent and longer view shows historically low growth in the past few years. Furthermore, the blame assigned to physicians and their medical associations needs to be shared with governments and most of all could be attributed to the lack of system structures and supports for improvement. New governance arrangements at the group or regional levels are needed but are insufficient in themselves. The additional features embodied in the Patient's Medical Home are essential for advancing primary care. Going even further, full population registration, greater availability of alternate payment arrangements, active participation of physicians in healthcare administration and support for meaningful measurement and feedback loops are among the changes required to transform Canadian medicare.