From: gld@cunixb.cc.columbia.edu (Gary L Dare)
Subject: Re: Canadian healthcare system
Reply-To: gld@cunixb.cc.columbia.edu (Gary L Dare)
Organization: Deep Space Nine (DS9)
Date: Wed, 27 Jan 1993 07:45:23 GMT

wc4209@writer.yorku.ca (Irene Berkovich) writes:
>gld@cunixb.cc.columbia.edu (Gary L Dare) writes:
>>
>>what the statistical population looks like: a bell curve.  
>>You can set your premiums according to projected demand and what 
>>the doctors demand from your fee schedule (we have the same AMA/
>>CMA-oriented monopoly as the U.S. and they get what they want).
>
>  You don't know what you are talking about.  

Sorry, but I'm old enough to have seen the process play itself out
in the newspapers up north a few times ...

>In Canada, the provincial governments set the fee schedule.  

Yes, during negotiations with the provincial Medical Association.

>If you don't like the fee schedule it's too bad, because it is
>illegal (under the Canada Heaalth Act) for a physician to "extra
>bill" above the government set rates.

Sure, or you can also opt out and charge cash (more on this later)
and apply to the provincial insurance for reimbursement on their
schedule.

>In the province of Ontario the yearly pay increases have averaged
>0.5-1.0% per year for the last six years.

Yeah, but the OMA agreed to their last contract during a period when
the Bank of Canada Governor was on a tight money policy that wrestled
inflation to the ground ... anyone who complains are like those hockey
players who foolishly signed long contracts and then free agency rules
get relaxed along the way ...

>In addition, most of the provinces have imposed fee caps on doctors.
>Doctors who bill above $450,000 per year in Ontario are paid only
>$0.33 on the dollar for all billings above 450K.  This has resulted
>in many specialists cutting back their work schedules so that they
>will not work in excess of the cap.  It iow takes much longer to see
>a specialist.

No doubt this will be a new source of distorted statistics for the
American debate presented to people who think we live in igloos ...
Of course, the folks at Monopoly Central ... errrr, the provincial
College of Physicians and Surgeons could just issue more licences.

I didn't realize that Ontario had put on a cap, but know that British
Columbia had put one in.  There, doctors freely opted out (there's no
law that you HAVE to accept the insurance ... if you do, you must
accept it at the fee schedule that your colleagues in the provincial
MA agreed to on your behalf) in protest.  The New Democratic (Labour)
government has shot itself in the foot over this issue, as it dropped
like a rock on the last Angus Reid polls while Gord Wilson's Liberals
have rocketed ... unfortunately, there's still two years to go before
an election there.  As for Bob Rae's New Democrats, you know what a
disaster that's turning out to be (maybe a warning to those who voted
Perot as a protest ... sometimes you get what you ask for ...).  I'm
surprised that Ontario doctors didn't just opt out for full cash fees;
but certainly they'll know that time is on their side and either Mike
Harris's Tories or Whats-her-name's Liberals will cut them a better
deal and with respect.  This is all a good example of how precious the
system is for Canadians; anyone in government who screws with it gets
burned.

Given this recent dire news, I would say that one improvement to our
Canadian provincial system with federal standards is more independant
freestanding "sickness funds" like Germany (NYT 1/23).  This fee cap
crap is a potential abuse of power than can be avoided ... unless the
party in power is honourable, as has been until recently in some
provinces ... our federal Liberal and Conservative (never NDP) gov'ts
have relied on the honour system for 20 years without problems.

gld

[Geez, my MD friend's America's Cup challenge idea is starting to
make sense ... we were still pretty sober at that time ...]
--
~~~~~~~~~~~~~~~~~~~~~~~~ Je me souviens ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gary L. Dare
> gld@columbia.EDU 			GO  Winnipeg Jets  GO!!!
> gld@cunixc.BITNET			Selanne + Domi ==> Stanley
Newsgroups: talk.politics.medicine