FEE CODE CREEP AMONG GENERAL-PRACTITIONERS AND FAMILY PHYSICIANS IN ONTARIO - WHY DOES THE RATIO OF INTERMEDIATE TO MINOR ASSESSMENTS KEEP CLIMBING

Background: ''Fee code creep'' is the increasing tendency of primary c are physicians in Ontario to bill for more intermediate than minor ass essments over time. The authors examine the extent and nature of fee c ode creep and describe physician characteristics associated with the c hanges. Methods: A cross-sectional and longitudinal analysis of Ontari o Health Insurance Plan billing and physician characteristic data was conducted for fee-for-service general practitioners and family physici ans (GP/FPs) in Ontario. The ratio of intermediate to minor assessment s (I-M ratio) was determined for the period 1978-79 to 1994-95, and th e relation of various physician characteristics to high ratios was tes ted with bivariate and multivariate analysis. Results: The I-M ratio r ose 10-fold, from 0.3 in 1978-79 to 2.9 in 1994-95. Although though th e I-M ratio was higher for older patients and young children, changes in population age profile over time did not account for any of the inc rease. The median ratio varied widely among groups of physicians: urba n physicians had higher ratios than rural ones (3.9 v. 3.0, p < 0.05), and recent graduates had higher ratios than physicians 60 years of ag e or older (5.1 v. 2.9, p < 0.05). The I-M ratio was inversely related to number of visits; physicians billing for fewer than 5000 visits ha d a median ratio of 4.2, whereas those billing for 20 000 visits or mo re had a median ratio of 1.6. Interpretation: Fee code creep has contr ibuted to expenditure growth in Ontario. This phenomenon was related t o both an increase in I-M ratio over time among physicians practising throughout the study period and an influx of new physicians billing at a higher ratio. Creep was not the result of aging of the population.