Out-of-the-blue proposal from NWT physician sparks lively debate 

SASKATOON | Canada’s doctors are divided over the question of whether privately paid fees for their services can be higher than the ones the provinces pay in the public system.

That is the essence of a Canadian Medical Association annual meeting debate over a delegate’s motion that°©, had the motion been supported, would have seen the CMA make a landmark stance on a controversial topic.

“We are about to experience an unprecedented expansion of private health care,” said Dr. Andrew Kotaska of Yellowknife. “In many private clinics expedited care is provided to patients who pay more.”

Social contract
He said his motion did not support or condemn private medicine but simply said that having higher private fees than public fees violated the “social contract” upon which medicare is based.

Dr. Kotaska’s motion read: “The CMA supports a requirement that any medical practitioners providing a medically necessary service to an eligible Canadian in a private health-care setting not bill or earn more for that service than they would in the public system.”

While much of the CMA meeting had been centred on improving “patient-centred care,” observed Dr. Shireen Mansouri, also of Yellowknife and the motion’s seconder, “to me a fee differential speaks to ‘doctor-centred care.’ ”

Calgary’s Dr. Carolyn Lane, echoing the opinion of a number of speakers who opposed the motion, said: “The sentiment has some value but this is a minefield,” adding, “It disempowers us.”

Dr. Lane suggested a regressive provincial government might be able to use this to stop doctors from working at freestanding abortion clinics. For example, a province could set the public fee for the procedure at $5, she said, and then freestanding clinics would be required to match that fee, and no one could afford to provide abortions at that rate.

 “The reality is we live in one big HMO; each province is basically a big HMO,” Toronto’s Dr. Larry Erlick said, referring to U.S. health maintenance organizations that are reviled by doctors and patients alike.

He said passing this motion would make doctors “totally enslaved to the whims of the provincial governments.”

Shelve motion: OMA
Ontario Medical Association president Dr. Suzanne Strasberg said she was concerned about what message the motion was sending—regardless of whether it was supported.

“This motion will derail the discussions (we’ve been having),” she said. Dr. Strasberg then requested that Drs. Kotaska and Mansouri withdraw the motion, but general council speaker Dr. Margaret Kirwan said now that the motion was introduced only council could dismiss it.

An attempt to refer the motion to the CMA board and thus avoid a vote was voted down.

Dr. Stan Lofsky of Toronto said he would have liked the motion to be withdrawn, but if that wasn’t to happen he would support it. “A fee differential is divisive,” he said.

In the end, 66% of CMA delegates voted against the motion.