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News Release
MRG critical of proposed delisting
The following brief was submitted by the Medical Reform Group
to the Joint Management Committee Panel reviewing the schedule of
benefits.
The Medical Reform Group is critical of the proposed delisting of
19 medical and surgical procedures from the OHIP fee schedule. When
the original list of 14 was made public in 1992, we believed this
approach to be a serious threat to medicare in the province. Even
with the new and more rigorously defined categories, we are still
convinced that any focus on delisting continues to risk the creation
of a two-tiered system, with no guarantee of any significant decrease
in health care costs.
The Medical Reform Group was established in 1979 out of a commitment,
by its founders, to the principle of health care as a right, and
a recognition of the basis of health as social and political in
nature. We agree that the Ministry of Health should consider deletion
of services for which there is no proven benefit and applaud their
responsiveness to public participation in these discussions and
decisions. But it is clear from the `qualifications' of the JMC
list that almost every considered procedure has `medical' indications,
if by that we mean that we understand health to have a broad definition
which includes emotional well-being and quality of life, not just
its prolongation. We are alarmed that the 'bureaucratization' of
these distinctions will have several effects:
1. Delisted services will have no limit on the fee that the physician
can charge. This was our initial fear of a two-tiered system for
those who can pay and denial of services to those who can't, but
for whom there may be a legitimate need.
2. Delisting encourages direct charges to patients. Third-party
billing has essentially delisted the annual health examination (Item
12), which in the absence of any `diagnosis' is most often done
at the request of an insurance company, school, summer camp, etc.
Many of us in general practice know that `sick note' charges are
rarely passed on to the employer, but are `out-of-pocket' expenses
for the patient. We are also aware of excessive charges to patients
for services such as the transferring of records (e.g. a patient
was charged $30 for photocopying of an obstetrical ultrasound report:
personal communication, Dr. Rosana Pellizzari). Mr. Bill Mindell,
of the City of York Health Unit reported that children were prevented
from attending school because parents could not afford to pay a
$40 physician fee to complete a Tuberculosis Control form required
by public health officials. These are clearly the equivalent of
"user fees".
3. Physicians will use their "OHIP-allotted" billings
to provide other insured services, challenging the argument that
health care costs will, by this approach, be lowered in any significant
way. In a fee-for-service system physicians have every opportunity
to maintain their incomes.
4. The other possibility is that physicians will be tempted to
provide more delisted services, for two reasons -- they are more
lucrative and they promise an easier 'physician lifestyle'. To quote
a Chief of Surgery: "If doctors can set their own fees for
these (delisted) services and in a sense work outside the system,
why would they continue to treat trauma patients? This way they
make good money and don't have to get up at 2 am." (Dr. Girotti,
Ontario Medicine, 20/9/93).
5. The notion of patient responsibility lives on the borderland
of victim-blaming for illness. If we consider travel malaria prophylaxis
to be an expense to the traveller (Item 14) what do we do if the
prophylaxis 'fails' and our patient returns to Canada with malaria?
What about suspected displastic nevi - they are benign but potentially
malignant - will they be 'covered'? (Item 9). We are very concerned
that we will see a repetition of the 'therapeutic' abortion committees
which presumed to judge the 'medical necessity' of a woman's choice.
What seems to be a benign plan on the first glance is not. It may
be tempting to 'cut and slash' what appear to be the offending agents
of our health care system, but our precious energy needs to be re-directed
to substantial reform of a primary care system that has revealed
its weaknesses. The Medical Reform Group has repeatedly called on
provincial governments to reform the delivery of primary health
care. We have strongly supported alternative methods of physician
remuneration and have called for the recognition of other health
care workers in the system. We advocate that the fee schedule apply
only to specialists, laboratories, and diagnostic imaging services
and that primary care be based on a salary or capitation system
which includes monitoring and accountability. We ask the NDP government
to abandon this misguided and hazardous project to `delist' services,
and renew its commitment to the principles of the Canada Health
Act - that it be universal, accessible, and comprehensive.
Dr. Rosana Pellizzari and Dr. Mimi Divinsky for the Steering
Committee of the Medical Reform Group of Ontario.
Subject Headings: Abortion
Rights – Community
Health – Community
Health Centres – Drug
Substitution – Epidemiology
– Epidemiology/Community
Medicine – Health
Administration – Health
Care Budgets – Health
Care Cost Containment – Health
Care Costs – Health
Care Delivery – Health
Care Finance & Fund-Raising – Health
Care in Canada – Health
Care in Ontario – Health
Care in the U.K. – Health
Care in the U.S. – Health
Care Myths – Health
Care Reform – Health
Care Resources – Health
Care Services – Health
Care Workers – Health
Clinics – Health
Determinants – Health
Economics – Health
Expenditures – Health
Issues – Health
Policy – Health
Policy/Seniors – Health
Service Organizations – Health/Social
Justice Issues – Health
Statistics – Health/Strategic
Planning – History
– Hospitals
– Labour
Medicine – Medical
Associations – Medical
Costs/Foreign – Medical
Education – Medical
Ethics – Medical
Human Resources – Medical
Personnel – Medical
Research Funding – Medicare
– Medication
Use – Medication
Use/Seniors – NAFTA/Health
– Occupational
Health & Safety – Patients'
Rights – Pharmaceuticals
– Physician
Compensation – Physician
Human Resources – Pro-Choice
Issues – Public
Health – Publications/Health
– Social
Policy – Women's
Health
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