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
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.
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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