An analysis of alternative funding for physicians practicing gynecologic oncology in Ontario, Canada prior to 2001.
Bibliographic record
Abstract
OBJECTIVE: To consider the policy issue of physician reimbursement by examining the events that preceded the Ontario Gynecologic Oncologists moving from a fee-for-service environment to an alternate payment plan in 2001. METHODS: The sources of information included a literature search, reviewing Canadian newspapers, interactions with key leaders in the field (Ontario Medication Association, University physicians), and meeting minutes from both university and provincial groups considering alternate payment plans. RESULTS: The problem for Ontario Gynecologic Oncologists involved the goal of providing excellent clinical care, undergraduate and postgraduate education, research and administration in the midst of problems with recruitment, retention and remuneration. Multiple causes for this problem included limitations in health care spending and a fee for service payment schedule that did not adequately reimburse complex care. This funding problem got on the agenda as a result of a front page article in the national newspaper and letters of concern solicited from local members of the provincial parliament. The policy formulation needed to account for alternate financial options and the roles of institutional structures such as the universities, Cancer Care Ontario and the Ontario University Health Science Centers. The influences on the evolution of the new funding policy included the actors, their interests, their values, research on the topic and institutions. CONCLUSION: The tensions between the goal of excellence in care, education, research and administration and difficulties with recruitment, retention and reimbursement, led the Ontario Gynecologic Oncologists to seek an alternate mechanism of reimbursement from the fee-for-service model.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.013 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".