Dealing with the Doctors: The Canadian Experience

In: Monthly review: an independent socialist magazine, Band 33, Heft 4, S. 27-35

Abstract

Reviewed is the development of the health care system in Canada, focusing on the role of MDs. It is concluded that the arrangements that were established to accommodate MDs at the time the medical care component of health care was introduced left the basic conditions under which medical services are produced unchanged. Moreover, in all provinces except Quebec, MDs were given, in one form or another, the right to opt out of Medicare arrangements & extra-bill patients. This opting-out provision built a "Trojan Horse" into the health care system that was activated when governments began to apply restraints to health care spending after 1974. Specifically, some MDs in some provinces exercised their right to opt out & extra-bill, thereby undermining the concept of universal accessibility. Emmett M. Hall (Canada's National-Provincial Health Program for the 1980's: A Commitment for Renewal, Ottawa, 1980) proposed that the threat posed to Medicare by such actions would be resolved if provincial governments outlawed extra-billing & agreed to submit impasses in negotiations over revisions to fee schedules to binding arbitration for resolution. Hall's proposal is rejected & it is argued that the fee-for-service system of payment & other remnants of the "medicine for profit" arrangement that were incorporated in the health care system must be eliminated if Canada is to make further progress toward "the achievement of socialized health care." 1 Table. Modified AA.