HomeMy WebLinkAboutThe Goderich Signal-Star, 1986-01-15, Page 6PAGE 6—GODERICH SIGNAL -STAR, WEDNESDAY, JANUARY 15,1986
Feature
Doctors say Iegislation will make them civil servants
BY SHARON DIETZ
Dr: Donald Neal is concerned about the
effects on the quality of care if doctors
become civil servants entirely under the
control of the province. It is the opinion of
Dr. Neal and his colleagues in Goderich
that legislation proposed by the provincial
government to end doctors' extra -billing
will rob physicians of their independence
making them employees of the province.
This legislation will give control of the
health care system to the politicians who
will then attempt to curb the rising costs of
health care,,says Dr. Neal.
The government can choose the number
of procedures doctors will perform in a
year which could lead to a lower standard
of care as surgeons will not have the flex-
ibility to do the number -of operations in
their area of expertise and interest.
The government could use capping,
limiting the number of procedures a doctor
can perform, to cut costs. The doctor then
has no choice but to accommodate by clos-
ing his office when he has performed the
number of procedures he is allowed and
taking holidays because he is not allowed
to practice.
"These changes are subtle. How,
demoralizing to be held on a leash like
this," comments Dr. Neal. "Gradually,
subtlely, slowly, people will stop acting
like professionals and act more like civil
servants."
Dr, Neal likes to view the issue of •the.ban
of extra billing as a censurnerr,
Looking at 'now the proposed legislation e
will affect the individual he sees the people
of the province losing the strongest, most
knowledgeable and most fiesty doctors
who are well meaning,dedicated people.
If they see something wrong, they go to
battle with the government for the quality
of health care. Nobody has their insight w -
to, the system. They effectively represent
patients needs and requirements, says Dr.
Nea 1.
That advocacy will be lost when the doc-
tors become employees of the system.
They will be a little more reluctant to
Legislation will cause the
deterioration of health care
• from page 1
Opted in physicians oppose the bill and it
won't affect them financially, says Dr.
Cauchi. The fight is for control of the
health care system and politicianswant
control of the system to curb rising health
care costs. Doctors maintain if the bill is
imposed, the politicians will call the shots.
Doctors believe the politicans will make
gross errors in judgement because they
know nothing about health care. Doctors
see a deterioration of the health care
system and patients will suffer.
"Doctors are interested in helping peo-
ple. Who do you trust.." asks Dr. Cauchi
who reminds people that the government
has done inappropriate things in the past
including their attempt to close the. Clinton
hospital, their closing of the Goderich
Psychiatric Hospital, their reluctance to
fund an intensive care unit at Alexandra
Marine and General Hospital which the
government now points to as a model
facility. The Goderich ICU .was built
without public money despite the protest of
politicians, observes Cauchi.
The funding of the health care system is
the basic thing, says Cauchi. The govern-
ment is providing total accessibility which.
is costing enormous amounts of money.
There is no such thing as free medical
care, says Dr. Cauchi. The government is
faced with a health care budget in this pro-
vince which is eating up one-third of: the
provincial budget to the tune of $10 billion.
The government believes it can Curb these
costs if it gains control of the health care
system by banning extra -billing by doc-
tors.
Basic problem
is underfunding
of health care system
Dr. Cauchi's view that the basic problem
is the funding of the health care system in
the province is shared by his colleague,
Dr. Donald Neal, of Goderich,` a family
practitioner who remains opted in.
tilare\gvectation of care is really high,
no Matter what the age of the person,"
says Dr. Neal who points to the increasing
aged population which will increase as the
baby boomers become senior citizens.
People live longer, more diseases are
treatable and more people live long
enough to require chronic care.
"We are only seeing the tip of the
iceberg in the expansion of people of the
age of 60 and over," says Dr. Neal. Physi-
cians spend twice the time on care of an
older person than they do on a whole fami-
ly
The government is turning its head and
ignoring .the realities by confronting the
doctors on the issue of extra -billing, says
Dr. Neal. But, the government has come
choices according to Dr. Neal. "We can
maintain accessibility allowing the service
to deteriorate and maintaining the ap-
pearance of accessibility while. quality of
care goes down. Or we can fund to meet
the needs which will bankrupt the province
or we can look at the direct participation of
patients in the cost of their health care."
User fees at the emergency department
of a hospital would allow some limitation
on the abuses which can occur and lead to
the realization that health care costs, sug-
gests Dr. Neal who is approves Dr.
Cauchi's proposals on alternatives to fund
the system. People may choose a private
insurance system or a user fee to provide
the province with extra measures of fun-
ding which would lead to an increased
awareness that it costs money to have
then services, says Dr. Neal. •
Ito uld force people to rethink some un-
necessary vists to the doctor and the dura -
Lack of accessibility
is a smoke screen
tion of hospital stay, says Dr. Neal. A per-
sonal incentive to be involved may not be
all bad.
Instead of coming up with practical and
realistic solutions to the problem'of health
care funding, the politicians prefer to bury
their heads where healthcosts are con-
cerned. Instead they come up with,.ways,pf„
deflecting their responsibility -by targeting
a highly visible groupsuch as the doctors.
The problems armre far reaching than
accessibility to doctors, he says.
Lack of accessibility is a smoke screen
when the patients real problem is
frustratin with thwarted plans and expec-
tations as they wait for long periods of
time for elective surgery and then have
their surgery cancelled at the last possible
moment because there is no bed in the
hospital.
There is a shortage of doctors in this pro-
vince as the government seeks to reduce
health care costs by cutting places in
residency prograrris. Dr. Mel Corrin's ex-
perience in attracting doctors to' the
medical practice in Lucknow since the
death of his colleague Dr; J.C. McKim is
one -example, says Dr. Neal. There have
been a series of doctors practice in
Lucknow with Dr. Corrin since Dr.
McKim's death in.1984.
The pattern of physician population in
this province is a profound problem, says
Dr.. Neal. There are manpower problems
the province loves to deny. There have
been no increases in the number of seats in
medical schools while many have gone to
the States to seek education in medical
schools there. Ontario has cut back. five
per cent per year for the last four •or five
years on its residency program. The pro-
gram for general practitioner
anaesthetists has , been cut and smaller
hospitals like Wingham have a real need
for such anaesthetists where there'isn't the
work for a fulltime anaesthetist.
"There are many cracks' in the system
but I want the attention directed toward
them rather than the myths the province is
drumming up," says Dr. Neal
NDP is instrumental
in extra -billing ban
New Democrats are,. proud to have been
instrumental in securing today's long over-
due legislative action to ban extra billing by 1
medical doctors, says the NDP Health Critic
Dave Cooke. -
Ending extra billing was high on the list of
proposals for action in the first session as
contained in the Accord which was signed
by the New Democrats and Liberals in May
1985.
"Our fight against extra billing has been a
long one. We have raised cases of financial
hardship caused to patients who are extra
billed, often having to pay several hundred
dollars more than OHIP provides. We hare
pointed • out the restricted access to care of
many specialists in many coMmunities. And
we have consistently fought extra lulling -
like other user fees and additional charges -
because it deters low-income people from
seeking the medical care they need and
deserve," says Cooke.
New Democrats have campaigned
throughout Ontario against eisttra billing. In
1979, New Democrats secured over 275,000
signatures in 'a province -wide petition cam-
paign calling for an end to extra billing. In
the fall of 1983 Dave Cooke, NDP Health
Critic ran a series of advertisements in dai'
speak out.
By enacting this legislation, a profession
loses its independence. It will no longer be
doctors serving their patients for a fee for
service arrangement. The doctor will be
won't discuss that,' " says Neal, referring
to the OMA's decision not to negotiate
extra -billing arid therefore refusing to
discuss. funding of the system with the
government.
Generally people do not perform well
when they have been conscripted
an employee dispensing a health care. ser-
vice for the government to the masses,
says Dr. Neal.
The doctor will lose that feeling of in-
dependent professional caring for his in-
dividual patient. He will not make that ex-
tra trip to the emergency ward at the end
of a long day or that house call he used to
make.
"Gen rally people do not perform as
well w as much care when they have
been conscripted," suggests Dr. Neal.
Overall', the tragedy is we have a system
that works well, he adds. Doctors have the
option now of opting out but over 80 per
cent choose not to.
There are ways to. compromise but when
you use a sledgehammer in your negotia-
tions there is no other option for the On-
tario Medical Association than to say 'We
'it's shocking that anybody could step
into a ministry which consumes one-third
or $10 billion of the provincial budget and
start dictating major change, especially
since he has no experience inhealth care
planning or provision;" says Dr. Neal in
referrence to. Health Minister Murray
Elston who has made several initiatives in
health care since his party became
--government at Queen's Park in June of.
last year,
"One would think he would look careful-
ly and then start initiatives, instead of be-
ing so brash and naive as to start such ag-
gressive change."
If enough pressure is allowed to build
over the rising cost of health care in the
province, Dr. Neal fears the Liberal
government. will allow licensing of private
hospitals as they have in England. This
will lead to a system of health care for the
rich who can afford to pay for private
health care and another public system for
the poor who cannot.
If you can pay, will you wait for a cornea
transplant and go blind for a year while
you wait for the doctor who cannot per-
form any more of these procedures this
year because the government limits the
number of procedures he can do'? asks Dr.
Neal. The public who can -afford to pay will
pressure the government for the service.
and the government will see this as an
alternative to funding the health care
system.
There is no such thing as free health
care,says Dr: Neal who believes people
must realixze their responsibility for the
cost of health care in the province. Dr.
Neal would like to see the energy of health
care professionals and the government
spent' on devleoping preventative health
care.
There is no inducement to live in a
preventative healthly manner, says Dr.
Neal. There is no money left for preven-
tative care in the system as it is now.
The study released last week which
outlines the critical underfudning of
cancer treatment centres in the province
and the deterioration in these facilities
couldn't have been more timely, says Dr.
Neal. The issue -is the under funding of the
health care system, not extra -billing by
physicians.
�ad�rch �t
BY SHARON DIETZ
A Goderich physician who is opposed
the ban on extra -billing by doctors because
it robs physicians of their professional
-freedom; has proposed an alternative
system for medical billing which he
presented to Health Minister Murray"
Elston recently,',
While Elston promised to consider the
proposal and was receptive to the:, alteir-
natives proposed by Dr. Mario Cauchi of
Bruce Street Family Medicine Centre, he
did not include any of the suggestions in his
ly newspapers in Ontario asking for ex-
amples of people who had beenextra billed.
The response was, overwhelming and many
of the cases were used in Question Period
with the health minister of the day to step up
pressure for a ban.
The Conservative Government refused to
respond even though the evidence of hard-
ships caused byxtra billing was and is still
overwhelming, Says Cdoke. The Liberals
were also in favour of extra billing. David
Peterson called it a "safety valve" for the
doctors until as recently as September of
1983 when the now -Premier 'endorsed the
NDP stand.
Continued evidence of public insistence on
an end to extra billing has finally prompted
an Ontario government to table legislation
to end this unacceptable practice. The NDP
is on record as supporting the Nova Scotia
model', which was proposed in," Dave
Cooke's priirate member's bill to bars extra -
billing, and is pleased that the minister has
., adopted this approach. The NDP is pleased,
too, with the minister's indication that the
current • chmpensati'on arrangements with
the medical profession will not be modified
in connection with today's legislation.
or proposes alternative
fairness for patients, government and senior citizens and patients on premium
physicians, Many
• of the ideas contained Iir assistance and welfare. These patients
the ';proposal are derived from his ex- could be given a cardsuch as is presently.
perienee in his own medical practice. { • done for Ontario Drug Benefit services
He proposes to disallow all physicians which would guarantee free medical ser-
�wra. billing for all hospital services. This vices in physicians' offices. ° -
oull apply to both in-patient and out- All opted out physicians in offices wod
gattent services. It would eliminate the up- bill OHIP for the portion coveredQUIP.
.
Fairness of patients being forced too accept This would reduce OHIP administrative
doctors, who are opted out during an; • costs of sending payments to individual.pa-:
emergency iilness.;It would also eliminate;, tier ts..:It would. allow the physcician :the.
the larger bills which _ are usually means of. billing :for disadvantaged and
associated with prolonged hospital stays • ether atients that he did not wish to bill
d' ensive operations.
du'ect�yt
legislation and proceeded to ban extra- an exp p .
billing and impose fines on doctors Who do All hospital services should be cornpen» The OMA tee schedule would be the ab-
not follow the legislation.. sated for by OHIP t the OMA fee rate, in solute nraximurn that can be billed by
Dr. Cauchi says he is the first to Dr.:Cauehi's proposal. This would provide opted out physicians..This would eliminate
acknowledge, there are problems in the'.. to physicians and would tend to thepossible abuse of the system by ex
health care system in this province He prevent many good physicians from leav- cessive billing It would also give physi
says he wants to -work with; the Ministry o!f lir g ':Ontario because by this gesture the cianc as a whole, compensation for their iiiservices. of 'sing a
•Health:,towards, solving these problems government would' demonstrate its good fair ompen ra ,ses the elimination
without robbing physicians of their profes- > will; This would : be better than the bonus I)r, . Cauchi , p po
sional independence., system which would be fraught with many the erroneous concept. of "super- doctors"
nistrative roblenis; such<` as: who deserving of special bonuses. It: is this con-
,The Ontario Medt�al Associatiou tOli�A.� `, adt�ai p The cept, he' says, which:has created much of
presented'his proppesal to the government decides who. should get the bonuses. p ,Y
and Dr. Cauchi ':met with the ;health,' finding for this could be obtained by the excessive billing to date. ..Dr. Cauchi
(!i /', t� suggests the .OMA. decide in its fee.
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didn't give the�governmentenou
and they want control, says Dr Cauchi'
In- his proposal, %'Dr. Cauchi says 1
agrees the medical billing system in On
tarso needs to be reorganized, however, he' rpatient has• a choice as to what physician
would prefer this be done using imaging lie attends in. a non -emergency situation..financial burden for patients and the
tion and good will to°devise a systerrr which' This would allow physicians'. professional pressure on government to continually in -
would serve as an example ,for other pro-; independence to continue. It would win crease OHIP benefits. This would reduce
vinces and countries."What I think would physicians'' good will and result in less op- goveriunent costs and provide monies re -
be a disaster would be for us to copy other pressed, happier physicians with the net quired for the„ increased cost of hospital
systems which, have failed, for example, result of better patient care, says Dr. benefits. •
the systems in Quebec' and England," he Cauchi. The_ proposal also • suggests private
says. Dr. Cauchi's proposal would not allow health insurance be an employee benefit so
Dr. Cauchi's proposal is a compromise disadvantaged patients to be extra- billed ' employers coulld help with the cost of this
system which he thinks :,Would 'provide:. in; physicians' offices. This would include insurance.
se
nes:: a Y ss3i� ti�A' A
'l'Iie alternative systerrr wou•
ld allow o
ting out to. continue in physicians'' private,
offices. This is fair This would not produce
hardships for 'patients because usually a
so iedule what' is appropriate for special
procedures pe Orme " .
Dr. Cauchi suggests in his proposal that
private insurance carriers be allowed to
cover the difference between the OHIP
and OMA fees, This would 'rediae the
iddell defends drug pricing revisions
BY JACK RIDDELL, M.P.P.
Huron -Middlesex
On Nov: 7, 1985, the Honourable Murray
Elston introduced, for debate in a duly
elected legislature, The Ontario Drug Benfit
Act, 1985, and the Prescription Drug Cost
Regulation Act, 1985.
The need for the legislation has been well -
substantiated by the Bailey Committee
Report (1978), the Gordon Commission
Report (1984), the Provincial Auditor's
Report (1984, and references in earlier
years), the Federal Eastman Report (1985),
and extensive correspondence and com-
ments from consumers, senior citizens,
third -party insurers, drug manufacturers,
and medical and pharmaceutical profes-
sionals.
The Ontario Pharmacists' Association has
expressed support for revising the drug
pricing mechanism and, in particular, Sec-
tion 155 of the Health Disciplines Act. The
legislation deals with these issues and pro-
vides clear authority for the government to
manage the Ontario Drug Benefit (ODB)
program.
"Price spread," which has resulted in the
Ontario government paying greatly inflated
prices for drugs, must be eliminated. It is an
unnecessary burden on Ontario consumers
and taxpayers.
The previous government was unwilling
to resolve 'the problem, perhaps in ° part
because the minister lacked' the requisite
authority to manage the situation. The new
legislation provides this authority, as well
as the flexibility to respond to anomal' s in
the drug marketplace.
The new legislation enhances cons er
protection and the potential for considerable
savings in drug costs (e.g. in your inven-
tory) through mechanisms to stimulate the
use of, and lower the price for, inter-
changeable drugs.
It also provides special. initiatives aimed
at protecting•theSmal�l-volume independent
pharmacy. These will ensure that no phar-
macist is paid a price by government which
is lower than his or her actual acquisition
cost, and will permit each pharmacy to
establish its own publicly identified fee for
prescriptions where interchangeable drugs
sire sold. For years, pharmacists have ask-
ed that this fee be unregulated. We areper-
mittingrythis with the provision that the con-
sumer be given sufficient information to
make appropriate choices.
QUEEN'S
PARK
- The government does not wish to place
small -volume independent pharmacists at a
disadvantage and is quite willing to consider
other mechanisms to provide additional
support.
Unfortunately, there seems to be a con-
sidera le amount of misinformation about
these issues. A few noteworthy examples
are:
1. that pharmacy originally brought the
"price spread" issue to the ministry's atten-
tion -
In fact, the previous government knew
. about the problem as early as 1971, and the
Ministry of Health identified it as a signifi-
cant issue in 1978. Action to correct the pro-
blem was initiated in 1979 and attempts to
rectify the drug pricing issue have con-
tinued since then. In recent years, the rapid-
ly escalating magnitude of the problem has
through ineffective government policy that
many parties ' including pharmacists, the
Ontario College of Pharmacists and drug
manufacturers found objectionable).
4. that the government is acting unilaterally
to impose the new legislation '
This is untrue. There is a long history of
consultation with interested parties and
their suggestions have been included in the
proposed bills.
Furtherniore, all parties ( drug manufac-
turers, consumers, wholesalers, senior
citizens, third -party insurers, and represen-
tatives of pharmacy, medicine and den-
tistry) have been briefed and asked for
detailed comments on the proposed acts and
regulations. 'While only minor changes to
the acts are anticipated, we. expect positive
changes to be incorporated into the draft
regulations before they are finalized.
increased concern. In addition, the Minister of Health has
2. that the ministry is unwilli a g to meet stated from the outset that both bills will go .
pharmacy representatives to resolve' to committee for public scrutiny, review
outstanding issues . and comment.
This allegation is simply riot correct. In conclusion, let me reiterate a few key
There have been many meetings over the points. -
past few months. The government is acting .now because an
3. that the legislation will have a serious and indefensible situation has gone on too long.
negative economic impact on retail phar- A long -overdue new ODB Formulary, incur- •
maciesporating price adjustments, 'new benefits,
"There is no doubt some cost reductions and consideration of federal sales tax ,in -
will result from the legislation and from creases, will be made possible.
changing the one-month supply policy under "Price spread" should cease to exist.
the ODB program. The intent of the government is to
But it must be remembered that a 'negotiate a fair and equitable ODB dispens-
prescription charge has two components - ing* fee, taking into., account relevant
drug cost, and dispensing fee. It, is difficult 1 economic factors.
to understand how predictions of economic' The consumer will be better protected.
doom for pharmacy can be substantiated Pharmacists will be free to establish their
when the level of that fee has not yet been' -1 own dispensing fees for non-ODB prescrip-
set. The Minister of Health has clearly in- tions.
dicated his commitment to. bargain in good The basic structure of ,the drug distribu-
faith for a fair and equitable fee. tion system irrOntario will remain unchang-
I trust you will agree that in 'addition to i ed, and the vital role of community.•phar-
negotiating a fair fee, it is both responsible macy will be preserved.
and reasonable for the government to . I trust this information is useful and that it
eliminate all indefensible increases in the will confirm that the ,government is acting
drug cost portion of prescription prices (i.e. ' responsibly and decisively to rectify an
"inflated'' prices previously' possible issueof great public importance: