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Excutive Summary


The Medical Reform Group supports bill 94 which would ban physician extra billing. The group is convinced that extra billing does compromise accessibility to our health care system. Numerous studies have shown that the most vulnerable people in our society, the poor and the elderly decrease their utilization of medical services in response to small user charges. These studies also demonstrate that these people are extra billed by Ontario physicians.

The Ontario Medical Association has expounded a number of incorrect arguments in their opposition to the proposed legislation. In summary:

* The OMA, not the government, is largely responsible for the OHIP fee schedule failure to reward excellence or experience.

* There is no evidence that opted out doctors are better physicians.

* There is evidence that there is little difference in practice styles between opted in and opted out doctors.

* It is very unlikely there will be an exodus of physicians after the legislature passes bill 94.

* Bill 94 will not make doctors into civil servants. Opted in doctors will continue to have clinical freedom.

* Public opinion massively supports an end to extra billing.

* The legislation will not directly lead to capping of incomes, restrictions of OHIP billing numbers, or controls on utilization. However, these are possible responses to legitimate problems affecting the health care system and the OMA should develop meaningful alternatives if they wish to avoid these "blunt" policy instruments.

* Physicians will continue to have effective bargaining tools without extra billing.

The Medical Reform Group acknowledges that a ban on extra billing infringes on the economic rights of physicians but feels that this must be judged against the rights of the public to access to health services without financial barriers. Also, the other economic benefits which society confers on physicians must be recognized. There are many characteristics of the health care system which make it unlike any other market. In fact most Canadian health care economists have pointed out that our health system should not be analyzed only in traditional economic terms.

There are many other pressing issues affecting the health care system. The Ontario Medical Association has claimed that bill 94 is a "smokescreen" for the real issue which is underfunding of the system. The Medical Reform Group reaffirms that extra billing is a real issue that affects hundreds of people every day. The group also points out the Canadian Medical Association Task Force on Funding which reported in 1984 found no evidence of overall underfunding of the system.


Recommendations

1. The government and the OMA should develop a fair fee negotiation process. This should involve a grievance procedure which would cover all issues related to physician remuneration including income capping and utilization restrictions. There should be provision for binding arbitration with a ban on a legislative veto.

2. The government should establish a Royal Commission on the financing of the health care system. It should provide facilities and funds for the public and non-profit organizations to become involved in the process. The commisssion should investigate alternatives to traditional delivery systems such as community health centres, and Health Sources. It should also examine the distribution of physicians and resources.

3. The government should take some simple steps to make medical practice easier. Plastic OHIP cards would facilitate the completion of forms. The Province of Quebec has provided these for a number of years. Better public information on Health Sources would make it easier for physicians who wish to pursue this alternative.

4. Bill 94 should be amended so that patients should not have to pay an opted out physician until he or she is reimbursed by OHIP.

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