In Canada, the vast majority of medical professionals work under the provincially funded healthcare system. However, a number of health services practitioners fall outside the funded system and operate privately, getting paid through personal insurance, employee benefit plans or out of pocket.
The member association of one such group of practitioners wanted to better understand the expectations of their membership. The executive director asked kisquared to undertake a survey of its members to ensure that any future changes would be beneficial and to measure overall membership composition, members’ business profiles and their satisfaction with the association. In addition, the association wanted to establish a process for ongoing member consultation.
A key issue for the executive director and other members of the board, who were private healthcare practitioners themselves, was the fact that it appeared to be harder for them to make a living providing their services than in years past. They knew anecdotally this was an issue for other practitioners who were not practicing within a medical institution, but wondered how wide spread the struggle was to make a reasonable living.
What we did
In consultation with the association, kisquared designed and executed a membership survey. Surveys were conducted by email or telephone when a member did not have an email address.
Through the consultation and survey development process, kisquared uncovered the fact that the association had no hard numbers regarding what it actually cost members per patient visit to deliver their services. This information was critical in terms of answering the profitability question. To determine the actual costs, kisquared facilitated a focus group of select association members, walking them through a cost analysis process.
What we found
Using a metric called the Net Promoter Score (NPS), kisquared determined a high rate of member satisfaction and loyalty. The survey further revealed that 66% of members were business owners with an additional 24% who were both business owners and employees. Half of the practitioners’ patients had insurance coverage for their care leaving many who pay out of pocket. About half of practitioners revealed that they had reduced their fees on occasion due to patient financial hardship.
Looking at the cost per visit of providing services determined from the focus group, the survey revealed that insurance claim allowances for this type of medical visit fell several dollars short of the total amount and that in many cases the fees practitioners charged did not reflect actual costs.
The executive director and board’s experience of finding it more difficult to remain profitable as a private practitioner was confirmed for the membership as a whole, most of whom also practice privately. Despite high demand for the services, many of their patients struggle to pay out of pocket related to higher than average levels of poverty due to disability and social issues. While the cost of providing the service is on the rise (e.g., medical equipment, supplies and administration) insurance coverage has not kept pace. More than 30% of members in private practice hadn’t raised fees in two years or more. Indeed, many members were struggling to make a reasonable living providing this particular healthcare service within a private practice and found themselves supplementing their income outside of their profession.
At the end of the study, the member association was assured of the support of its membership and had a structure in place for ongoing consultation. It also had a roadmap to revamp its programming to meet the changing needs of practitioners. The survey and focus group process revealed an overwhelming need to support members with education and resources related to business skills and development, something it had never offered previously. The association also had clear, documented information about the cost of providing the service that it could use to advocate for increased insurance claim rates as well as support from the provincial healthcare system.