HomeMy WebLinkAboutThe Goderich Signal-Star, 1986-01-29, Page 17Comrnunit News
Extra-billiilg is not the issue in dispute ®® ®
in a country which purports
to have a for it.
• from page 1A Socialized National Health System there is
fectively shut off any competition that a lack of uniform accessibility and a very
might have lowetred rates and saved the definite two tiered system. The OMA for
11,11 taxpayer dollars. years now has implored the government to
k When the government became the sole allow private insurance back into the
insuring agent for health services in 1969, scheme of things in Ontario. The unions
they. agreed by legislation to pay 90% of would leap at this as a negotiable work
. the Ontario Medical Association fee in benefit and this certainly would free up
their Schedule of Benefits. This quickly government health dollars for necessary
kwent by the Beard and by 1979, the ihysi- and urgent funding of not only hospitals
cians were receiving only 65% of what they and needed equipment, but also public
should have been receiving under, a fair health and teaching programs including
; .: tariff. This has improved slightly so that research that g'umply cannot be funded
now the benefits cover approximately 75% under our present system.
f of the OMA fee. Nevertheless, I dare say The vast majority of opted -out direct
s. we are the only group of people in Canada, billing physicians and surgeons charge .
professional or otherwise, who are virtual- their patients far less that the Ontario
ly taxed at 25% before being paid.•Can you - Medical Association fee for service. Many
1- conceive of the Bar Association entering of us feel obligated to deal with our pa-
into any such agreement? tients directly simply to maintain our in-
In any form of insurance such as car or dependence. As you can See from the flyer
house insurance, one can never expect to that' all my patients receive, I am, in fact,
receive full compensation. The insured losing money because a 2% surcharge does
t_ person always has to pay out of pocket in not cover my bookkeeping and mailing
addition to the insurance payment to get costs.
'full value. Medical insurance is similar in I am pleased to report however, that our
• that your OHIP insurance only covers 75% surgical equipment fund has received
of the doctor's fee. It means simply that several hundred dollars in donations, so
the government is not offering you good in- that many ofmy patients, 1' have to
$ surance value. Those physicians who are believe, feel that the Ontario Medical
w. opted -out of OHIP and bill their patients up Association fees are not outrageous and at
to the OMA fee are not "Extra Billing" at the same time recognize the problems that
all. The government is simply, by lack of community hospitals are having in main -
funds, underpaying physicians for their taining up to�late equipment and facilities.
1 services. Finally, the issue before us is purely one
t It also means that 88% of the Medical of health care funding. The issue of "extra
Profession in Ontario, at this time, are billing" is a total obfuscation of the truth of
willing to forgo 25% of their fair fee to the matter and that is simply, that if you
avoid the added stress of dealing directly want quality care (hospitals, facilities,
with their patients over financial issues. research, nursing homes, preventive
This, of .course, means that the patient has medicine program then you have to pay
no sense of the value of the service that has
been rendered and judges that the service
is free. Almost always anything that is free
is overused, There is no question that some
patients, knowing that their medical pro-
blems are being paid for by a third party
(OHIP), have no compunction about call-
ing their physicians for trivial complaints.
Direct billing 'with the knowledge that
there will be a nominal fee helps to
discourage this kind of misuse. The cor-
ollary to this is the fact that direct billing
lets the patient know what professional
medical care and.services have been given
and what they are worth. It assures that -
there will not be a physician overutiliza-
tion of the system. Being opted -out and
billing a fair fee (at, or below the OMA
tariff) makes for honesty, and responsibili-
ty by both the patient and doctor and tends
to prevent the insuring third party from,'
being exploited.
The proposed legislation states that a
physician, dentist or optometrist shall not
charge more or accept payment for more
than the amount payable under the plan
for rendering an insured service to an in-
sured person. In fact, that makes a hither-
to independent and honourable profes-
sional nothing more than a Civil Servant to
be paid at a rate to be determined by a
Government Bureaucrat. Once this has
happened there is nothing to prevent that •
same bureaucratic process from imposing
economic sanctions as happened in
Quebec, where patients of direct billing
doctors receive no insurance payments
from their government insurance plan. In-
deed in Quebec, a ceiling has been placed
on doctor's earnings, so that no matter
`• how conscientious and hard working a doe-
' for may be, his income is limited. The
result of this is that many physicians in
Quebec simply stop working for the rest of
the year if they have reached that ceiling.
Once the government has a total finan-
cial hold on physicians then they can by
: coercion and legislative means determine
where a Doctor` shall practice, how many
physicians there shall be in a certain area
and how many specialists of one sort or
another shall be allowed to practice in a
certain location. The independence and .
freedom of the medical community will
have been lost, and professional care and
service as we know it today, will be gone
forever. The patients' freedom of choice as
far as selecting a physician will be in
jeopardy and I suspect that meaningful
. conscientious care on the part of many
physicians wilt be a thing of the past.
The ban on billing a fair fee for services
will certainly affect many of the major
centres where there are super specialists
of extremely high caliber. Many of these
qualified, irreplaceable specialists will un-
questionably leave the country leaving a
, large void in certain areas, not only in
technical expertise but also in teaching
and research.
The public is simply not aware of many
of the unpaid hours that physicians work
largely on a voluntary basis to insure
quality care in community hospitals such
as ours or in a teaching capacity in Univer-
s sity centres. Once we have become, in ef-
feet and by legislation, Civil Servants, then
much of the incentive for reaching for ex-
cellence will be gone. The public's health
• needs and the quality of care cannot help
but suffer. '
• One of the alleged aims of the govern-
ment is to. do away with MVP premiums
altogether. For a majority of the working
population this will make no impression
whatsoever because their OHIP premiums
. y are,being paid by the companies that they
w work for as a contract benefit. Many peo-
ple do not know what their premiums cost.
What it may do is to allow big business to
get off the hook for millions of dollars
worth of premium payments. It will cer-
tainly increase general taxation in all in -
Come brackets. It will put even more of a
squeeze on the health care dollar and
k reduce still further essential and im-
mediate funding for necessary facilities. It
is a fact that in any country that has taken
on socialized medicine in its entirety (the
United Kingdom's- National Health Ser-
vice) the health carp has deteriorated to
. the point where the public has demanded
reintroduction of private insurance to pay
t for essential health care. In Britain, over 6
million people are covered by, private in -1
surance and have access to private
hospitals and private physicians and
surgeons working o°n$side of the_system.
,: There is a waiting list of over twin years for
a hip replacement in Britain under the Na-
tional with
Health Service. Patient
n
al
do
private insurance can have their opera-
tions within a month. So you see that even
The povernntent constantly refers to the
50 million dollars per annum that they will
receive from the federal coffers, if they
can either opt all physicians into thepHIP •
scheme or disallow any form of direct bill-
ing that exceeds the OHIP rate. As I have
mentioned the government refers to this as
extra billing. In virtually 100% of the cases
we are not dealing with extra billing at all,
but simple underpayment by the public's
medical insurance plan of a fair fee for
services. As I have pointed out there are
many opted -ort physicians who charge far
below the full OMA rate. The 50 million
dollars is a grossly inflated figure based on
assuming that all opted out physicians
charge the maximum OMA fee. This is
pure blackmail on the part of the govern-
ment. The issue is not a monetary one as
far as physicians are concerned. It is simp-
ly an endeavour to maintain excellence for
our patients and to ensure independence
and freedom not only for the physicians
but for our patients in maintaining the
right to deal honourably witheach other.
• The reason the OMA has not negotiated
with the government over this issue is
simply that there is nothing to negotiate
since the government will do what it
wishes in any case. It is a bit°like asking a
condemned man whether he would like to
be shot with a .22 or a shot gun. Over the
years we have come to realize that con-
tracts with government cannot be trusted
and that they can be broken at will by the
whims of the politicians for expendiency
sake. If this legislation goes ' through, we
predict that the future standard of medical
care in this province will continue to slide
downhill. -
Kenton C. Lambert, M.D., FRCS(C
,mnav,
GODERICH SIGNAL -STAR, WEDNESDAY. JANUARY 29,1986—PAGE 3A
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