Ontario family physician perspectives on whether and how to charge patients for uninsured services: Qualitative study.

OBJECTIVE

To explore family physicians' decision-making process regarding charging patients for uninsured services in Ontario.

DESIGN

A secondary analysis of 55 interviews from a constructivist grounded theory study on before-tax income differences among Ontario family physicians.

SETTING

Ontario.

PARTICIPANTS

Independently practising family physicians.

METHODS

Interview transcripts were analyzed using inductive content analysis. Key patterns pertaining to charging decisions and processes were identified through iterative coding. Categorization matrices were developed, enabling comparison of key dimensions related to practice features and physicians' charging decisions.

MAIN FINDINGS: Participants varied in their approaches to charging for uninsured services, describing decisions as shaped by value-laden negotiations between professional commitments and system-level inadequacies. Across remuneration models, rising financial costs and administrative burden influenced charging decisions. Some physicians viewed charging as necessary to support the costs of practice and manage administrative workload, while others described fees as misaligned with their commitment to delivering accessible, equitable care or as adding a new administrative burden. When deciding whether and how to enforce fees, physicians often made exceptions based on perceptions of patient financial circumstances.

CONCLUSION

The findings suggest that while addressing financial shortfalls and reducing volume of unpaid administrative work are key motivators for charging for uninsured services, fees may simultaneously introduce new ethical and operational challenges. Addressing family physician remuneration for administrative and uninsured services is essential for reducing these tensions and sustaining core family medicine values.