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
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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