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MEDICAL REFORM Newsletter of the Medical Reform Group Issue 132 Volume 24, Number 3 Winter, 2005 BLOCK FEES UNDERMINE ACCESSIBILITY TO HEALTH CARE: DOCTORS’ GROUP CALLS ON GOVERNMENT TO BAN PATIENT CHARGES Irfan Dhalla and Gordon Guyatt he Government of Ontario longer make appointments if they re- But what is surprising, and dis- claims commitment to the Cana fused the annual fee. Everyone agrees turbing, is that the College of Physicians Tda Health Act, and ensuring that that these practices are unacceptable— and Surgeons of Ontario, a regulatory ability to pay doesn’t influence access to the important question is how to pre- body whose duty is to protect patients, care. But doctors have found a way vent them. has also endorsed block fees. Last month, around this principle and, so far, Premier It’s no surprise that the Ontario despite clear evidence that doctors con- Dalton McGuinty and Health Minister Medical Association wants to keep block tinue to violate the College’s existing block George Smitherman are letting them get fees regulated as loosely as possible. An fees policy, the College voted to contin- away with it. OMA representative has said that “Of- ue to allow doctors to charge these fees. If you are lucky enough to have fering block fees can actually improve The College’s decision comes despite its a family doctor, you may have recently the pay-as-you-go system…[They force] admission that it has neither the resourc- received an unwelcome request. The doctors to be more business-oriented.” es nor the intent to actively monitor and doctor, or more likely the doctor’s re- In fact, block fees have become so pop- enforce the administration of block fees. ceptionist, might have asked you to pay ular that a small industry has sprung up The Medical Reform Group, an a block fee—an annual payment, levied to make sure doctors are maximizing association of doctors and medical stu- in advance, for services not covered by their block fee revenue. dents who believe that all Canadians your provincial health insurance plan. should have equitable access to high-qual- Block fees are supposed to cover serv- ity health care, has been trying to persuade ices such as telephone prescription re- the College to put a stop to block fees. newals and the completion of summer INSIDE With last month’s vote, however, the camp forms. College regrettably put doctors’ interests In theory, patients can opt to pay above patients. for uninsured services on an a la carte basis Fortunately for Ontarians, under rather than en bloc. In practice, however, Releases............................3,4,8,14 the recently passed Commitment to the Fu- most patients find it very hard to say ‘no’ Primary Care Reform.........................5 ture of Medicare Act, the provincial gov- when their doctor asks them to pay for Working Group call.............................5 ernment has the power to regulate block services in advance—even if they know fees—or ban them entirely. The MRG Steering Committee..........................6-7 they will never need those services. prefers an outright ban—with over 20 Even worse, many patients face Pharmacare.........................8-14, 19, 20 000 doctors in Ontario, monitoring the the threat of losing access to their family Guyatt Columns...........................15, 16 use of block fees would be a significant doctor if they don’t pay a block fee. One International Health--Nigeria....17-18 administrative challenge, and a waste of doctor’s patients were told that their tel- resources. Moreover, no realistic over- ephone calls would go unanswered un- sight could prevent physicians from con- less they paid up. Another doctor’s Please visit ourweb-site: tinuing to stretch the rules, and the patients http://www.hwcn.org/link/mrg patients were informed they could no (continued on page 2) Medical Reform Group, Box 40074, RPO Marlee Toronto, Ontario M6B 4K4 MedicalReform BLOCK FEES UNDERMINE ACCESSIBILITY TO HEALTH Medical Reform is the newsletter of the Medical Reform Group of Ontario. CARE (continued) Subscriptions are included with member- ship, or may be purchased separately at $50 per year. Arrangements to purchase most likely to be harmed—the poor and practice of charging large annual fees multiple copies of individual newsletters the elderly—are unlikely to complain. for extra services and preferential or of annual subscriptions at reduced There are useful actions the gov- access. Only a small number of doc- rates can be made. ernment could take short of prohibiting tors in Ontario are using the block Articles and letters on health-re- block fees. First, the government should fees policy in this way now, but little lated issues are welcomed and can be sent to <[email protected]>. insist that doctors who charge a block stands in the way of many more fam- Contact us at: Medical Reform, fee inform OHIP of both the amount ily doctors opening up boutique prac- Box 40074, RPO Marlee, Toronto M6B of the fee and the name of each patient tices. 4K4. Phone: (416) 787-5246; Fax (416) 352- that is paying the fee. In an ideal world, where pa- 1454; or <[email protected]>. Second, doctors who charge tients and doctors were on an equal Opinions expressed in Medical block fees should provide each patient footing, block fees for uninsured serv- Reform are those of the writers, and not necessarily those of the Medical Reform with government-authorized material ices might be acceptable. Until and Group. outlining the patient’s rights. This docu- unless we get there, doctors should ment should specify that physicians can- recognize that block fees often un- Editorial committee this issue: PJ not charge patients for the more dermine accessibility. The Govern- Devereaux, Bradley MacIntosh, Janet conscientious provision of an insured ment of Ontario must not permit Maher. service, that physicians cannot charge pa- this stealthy erosion of the Canada ♦ The Medical Reform Group is an tients for being more available, and should Health Act. organization of physicians, medical stu- inform patients how they can complain First published December 11, 2004 in Straight dents, and others concerned with the if they believe their doctor is violating Goods. health care system. The Medical Reform these guidelines. Group was founded in 1979 on the basis Third, the government should of the following principles: explicitly ban “boutique medicine”—the 1. Health Care is a Right. The universal access of every per- son to high quality, appropriate health SUBSCRIBE to STRAIGHT GOODS: care must be guaranteed. The health care system must be administered in a manner ince 2000, Straight Goods has been an independent Canadians on-line which precludes any monetary or other news and information source on a range of issues that matter: politics, deterrent to equal care. Sworld events, health and health care, the environment, workplaces, consumer and social issues, education and much more. 2. Health is political and social in na- Publisher Ish Theilheimer of Golden Lake, Ontario and Editor Penney ture. Health care workers, including phy- Kome of Calgary head up a virtual national team of writers and editors who sicians, should seek out and recognize work to put out a national weekly at www.straightgoods.com, that is fresh, the social, economic, occupational, and pertinent and useful to its readers. environmental causes of disease, and be Straight Goods publishes a free weekly email bulletin which offers links directly involved in their eradication. to approximately two dozen new articles by authors such as Linda McQuaig, Gordon Guyatt, Mel Watkins, Marc Zwelling, Gwynne Dyer. 3. The institutions of the health system must be changed. Annual subscription fee of $30 ensures access to full archive of articles. The health care system should be To subscribe, please send a message to [email protected]♦ structured in a manner in which the equally valuable contribution of all health care workers is recognized. Both the pub- lic and health care workers should have a direct say in resource allocation and in determining the setting in which health care is provided. 2 Medical Reform Volume 24, Number 3 - Winter, 2005 COLLEGE OF PHYSICIANS AND SURGEONS SHOULD VOTE DOWN POLICY PERMITTING PATIENT CHARGES On November 25, the College of Under both the current and pro- According to the College, recent Physicians and Surgeons of Ontario posed policies, physicians are allowed to violations of the block fees policy include: will make a crucial policy decision charge patients for uninsured services ♦ Doctors charging block fees as a concerning “block fees”—flat fees (e.g., telephone prescription renewals, condition of being accepted into a charged in advance by doctors for completing forms for summer camp, practice services not covered by the Ontario etc.) either individually or with an annual ♦ Making patients pay for services Health Insurance Plan. The Medical flat fee. Under the flat fee policy, patients that are covered by OHIP (for ex- Reform Group is now publicly urg- often pay for services they never use. The ample, requiring payment for a spe- ing the College to ban the practice of College has proposed a new draft poli- cialist referral) charging block fees. cy that allows patients to refuse to pay ♦ Terminating patients from a prac- “The College knows that many the fee, and bans physicians from penal- tice for not paying a block fee doctors violate the existing block fees izing patients who refuse to pay the block ♦ Not responding to telephone mes- policy,” said Dr. Irfan Dhalla, spokes- fee. sages from patients who refuse to person for the MRG. “For example, “The College’s regulations might pay the block fee doctors have asked patients to pay a work in a dream world, but we live in a “Block fees benefit doctors but fee before allowing them to join their province with a severe physician short- not patients,” said Dr.