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The reason there are such long waits for care, in Ontario as across the country, even as health spending now absorbs nearly half of provincial budgets, isn’t because providers aren’t working together in teams. It’s because the system uses resources so inefficiently.

It does so because, for the most part, nobody knows what anything costs. We do not have information on costs, because nobody has the incentive to collect it. That won’t change until we change the way the system is funded — not the public funding at its source, but the way in which those funds flow through the system: the way people get paid, to be vulgar about it.

Right now doctors are typically paid on a fee-for-service basis. Surgeries and other treatments, on the other hand, are paid for out of hospitals’ global budgets. This has it exactly backwards. When doctors are paid fee-for-service, they have an incentive to load up patients with services they don’t need; patients, for their part, have neither the incentive nor the expertise to resist. Which is why the trend of late has been to pay doctors by a system known as capitation: a flat annual flee for each patient enrolled in their care, adjusted for particular risk groups.

On the other hand, when hospitals fail to price the services they provide, there is no way for competitors, such as specialized clinics, to undercut them, and no incentive to find ways to do them more efficiently. And who should pay for those services? Why not the doctors who refer their patients to them, out of the share of public funds allotted to them — the capitation fee. In effect, doctors would act as surrogate consumers on patients’ behalf.

So the really interesting unanswered question about these new teams is how they are to be funded. Doctors already have both the know-how and the incentive, via the Hippocratic oath, to do what’s best for their patients; giving them a budget constraint would incentivize them to do what’s best for taxpayers as well.