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Medical Group urges end to opting-out

April 1, 1980


An Ontario physicians' group says opting out of the Ontario Health Insurance Plan is "completely unacceptable" and contrary to the principles of "reasonable and fair access" to health care guaranteed in Canada's medical care legislation.

The Medical Reform Group of Ontario made the statement today in a brief presented to Justice Emmett Hall at the Health Services Review hearings in Toronto. The Medical Reform Group is an organisation of almost two hundred physicians and medical students formed to express their concerns about the future of health care in Canada.

The Medical Reform Group brief states that opting-out hurts the over-all quality of medical care by inflating the total costs of health care. Opting-out allows a physician to bill the patient whatever fee the physician chooses. The patient recovers only a portion from the provincial health insurance. In Ontario at this time this amount is usually 70 percent or less of the physician's fee. They add that the percentage of physicians opted-out in any one specialty varies from zero to one hundred percent in different areas of Ontario, meaning increased health costs are unequally distributed in the province. They cite an Ontario Ministry of Health list of physicians from last December to show that "all urologists in Peel, Halton, and Wellington counties and in the city of Peterborough, all obstetrician-gynecologists in Nipissing, and all anaesthetists in Middlesex county" have opted out of the medical plan.

But opting-out isn't the only factor affecting the quality of Ontario's health care. The MRG says the introduction of medical insurance programs were "an attempt to correct inequalities in the access to medical care by eliminating direct costs to patients. However, their introduction did nothing to alter the way in which health care is delivered, nor to change the power structure within the health care system."

The MRG wants health care spending in Ontario increased to keep pace with inflation; the physicians call for an end to hospital bed cuts and hospital worker layoffs. They say this is necessary to maintain the principles of "reasonable access" and "universal coverage" for Ontario residents.

The brief to the Hall Commission calls for an end to Ontario's costly OHIP premiums since they are a regressive form of taxation. The heaviest burden falls on those least able to bear the cost. The brief suggests that shifting the cost to the corporate and personal income tax sector of financing with a system of tax credits for those unable to afford a tax increase could provide a progressive system of financing.

But the physicians also point out that a major source of complaints about OHIP stem from its bureaucratic administrative procedures which often seem "designed to harass the physician." The brief calls for a streamlining of OHIP paperwork to make the plan more attractive to physicians. The MRG also wants the OHIP fee schedule to allow fuller remuneration for efforts at preventive medicine. The brief also calls for an over-all increase in spending on preventive programs. "At present in Ontario, only 3.1 percent of the health budget is earmarked for "community health", and even much of this small sum does not go to preventive programs. In the face of mounting expenditure on technology-intensive, treatment-oriented facilities, there is a need for increased spending on preventive programs which might reduce the need for medical intervention."

The MRG brief says doctors could possibly be kept in OHIP by a combination of a substantial fee increase and health insurance legislation similar to Quebec's. In Quebec, patients receive medical benefits only if they receive care from opted-in doctors. However, the MRG believes that considerably more use should be made of alternatives to fee-for-service as a method of paying physicians. Many physicians would welcome the opportunity to practice under a salary system, a method now used to pay certain public health physicians, radiologists, anaesthetists and pathologists in Canada.

The brief concludes by saying: " On all fronts we are being challenged to shift our focus beyond the individual and his or her problems, to the complex of factors that gives rise to these; health care is becoming less and less the private concern of the individual, and more the public concern of the whole society."

COPIES OF THE BRIEF ARE AVAILABLE AT THE HEARING
Further copies can be obtained from the Medical Reform Group

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