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William Cunningham, President of Doctors of B.C., says the auditor’s report is challenging health-care providers to break down siloes and work in the same sandbox.

DARRYL DYCK/THE GLOBE AND MAIL

The B.C. government pays the province's doctors billions of dollars but has no ability to make sure taxpayers are getting the best value for those salaries, the Auditor-General says.

The Liberals are already under fire for increases in medical-services premiums announced in this week's provincial budget, and on Thursday faced pointed questions from Auditor-General Russ Jones over the $3.6-billion it paid to about 10,000 physicians in the province in 2011-2012, the latest figures available to researchers.

"We found the government is not ensuring that physician services are achieving value for money. Government is unable to demonstrate that physician services are high-quality and cannot demonstrate that compensation for physician services is offering the best value," Mr. Jones said in his report.

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"Overall, government does not know if physician services are high quality and offering good value for the money spent. This calls into question government's ability to make informed decisions regarding physician services."

Mr. Jones writes that "entities" such as the health ministry and the College of Physicians and Surgeons are "working in silos," leading to gaps in evaluating the effectiveness of the services doctors provide.

Also, Mr. Jones said the government has not effectively defined what "value" or "cost effective" means in terms of physicians services.

He said the current model, in which most physicians are paid for the services they perform, encourages doctors to provide a high volume of services, but no system is in place to measure their effectiveness.

William Cunningham, president of the Doctors of B.C, formerly known as the B.C. Medical Association, said doctors are providing quality care, but more could be done to measure it effectively.

"We agree that many of these things not measured should be measured," he said, noting that B.C. has the best cancer-survival rates in Canada, and best outcomes for heart disease.

Dr. Cunningham, an emergency-room physician from the Vancouver Island community of Duncan, said his organization is prepared to work with the government. "[Mr. Jones] is challenging us to break down silos and work together in the same sandbox."

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Judy Darcy, the B.C. NDP health critic, called the situation outrageous. "We're talking about nine per cent of the entire provincial budget and the Auditor-General has basically called out the government and said, 'You have no process for measuring physician excellence and whether methods of payment are providing the best outcomes,'" she said in an interview. "For a government that continually tells the public they are responsible guardians of the taxpayer dollars, it's pretty outrageous."

Mr. Jones offers six recommendations for improving the situation. They include clarifying the roles of agencies involved in health care, and possibly adjusting options for paying physicians to encourage high-quality, cost-effective services.

In Victoria, B.C. Health Minister Terry Lake thanked Mr. Jones for "some really good suggestions," and noted the province is already pursuing some of them.

"We are working very closely with the Doctors of B.C. on value for money. And when you look at the population levels and the health-care outcomes, I think people could say our health-care system is providing value for money. And physicians are a big part of that."

Although Mr. Lake said there are now more alternative payment methods for physicians, and some doctors are now on salaries, the fee-for-service model has been consistent across the Western world.

Still, the minister said the province is striving for a more collaborative approach on modernizing the health-care system.

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With a report from Justine Hunter in Victoria

Follow me on Twitter: @ianabailey

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