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EXCLUSIVE: changes proposed to OHIP coverage

Updated: Mar 4, 2023

Big changes are being proposed to healthcare coverage in Ontario as the provincial government is looking to find half a billion dollars worth of savings from within OHIP, CityNews has learned.

Tests and procedures ranging from diabetes and pain management to colonoscopies are under review by an “appropriateness” working group made up of doctors from the Ontario Medical Association and government officials. The group is looking at latest and best practices to see what medical tests ordered by doctors are unnecessary, overused or inappropriate.

OHIP services have not been carefully examined in years as doctors did not have a contract with the province. A new contract was agreed upon in February and the working group to find savings is part of the agreement.

The deadline for the group to agree to reductions worth $100 million is May 1 and the next deadline to save an additional $360 million is Sep. 1.

Documents obtained by CityNews show that if an agreement is not reached by those dates, the issue will go to an arbitration panel which will determine where $460 million in savings will be found.

The documents estimate “as much as 30 per cent of medical services in Canada are unnecessary and inappropriate.” They also state that “there is evidence that less than 4 per cent of Ontario’s family doctors are responsible for ordering nearly 40 per cent of tests of low value.”



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