By: Pat Daley
Forget boondoggle. Statements by the Ontario government in the middle of negotiations with the Ontario Medical Association (OMA) are a mindboggle.
This is the government of Michael D. Harris, the man who said that if teachers won't volunteer for extra-curricular activities he'll bring in legislation to make them volunteer. This is the government that outlawed squeegie kids; the government that brought in mandatory workfare and made sure - as of this Saturday - that anyone convicted of welfare fraud is barred for life from getting assistance.
This is the government that's afraid of nothing and no one.
So why have they caved in to the OMA on primary health care reform?
Primary care is the first contact people have with the health care system - usually with their family doctor. Regular Straight Goods readers will have found it mentioned in points five and six of Seth Klein's Rx for medicare. Although there are variations in recommendations that have been made for reform, the main elements that come up from coast to coast are the elimination of the fee-for-service method of paying family doctors and the creation of group practices using doctors, nurse practitioners, social workers, and other health care professionals.
In Ontario, primary care reform has also meant rostering. That's a system where a patient actually registers with a physician or nurse practitioner of their choice, usually in a group practice. While a person may be able to get a second opinion, there's no shopping around and no getting the same tests ordered by several different doctors - with the taxpayer being dinged each time. The practice as a whole is funded on the basis of the number of patients registered (with a number of variables based on population characteristics like age) rather than the procedures performed. Everyone in the practice receives a salary, which allows them to spend time on preventing illness instead of cramming enough procedures into a day to pay the overhead.
There are seven pilot projects currently underway, co-ordinated jointly by the OMA and the provincial government. Besides rostering - which more than 150,000 patients have already done - the pilots include 24-hours-a-day, seven-days-a-week access to health care advice.
The support for this type of reform is huge. Similar proposals have come over time from organizations as diverse as the Medical Reform Group to the Harris government-appointed Health Services Restructuring Commission (HSRC). The National Forum on Health, which reported in 1997 after two years of research, said primary care reform that includes getting rid of fee-for-service payment is high on the agenda of all provinces and territories.
Even groups that have opposed the Harris government on every other front want to see this reform proceed quickly. Earlier this year, a new Coalition for Primary Health Care called on the government to act immediately on the HSRC recommendations. The Coalition includes:
Association of Ontario Health Centres
Association of Ontario Midwives
Campaign 2000 (to eliminate child poverty)
Canadian Pensioners Concerned - Ontario Division
Dietitians of Canada
Medical Reform Group
Older Women's Network
Ontario Association of Medical Radiation Technologists
Ontario Coalition of Senior Citizens' Organizations
Ontario Nurses' Association
Registered Nurses Association of Ontario.
In fact, it seems like the only ones who want to go slow on primary care reform are the members of the Ontario Medical Association. Talk about a special interest group. You'd think a government might be inclined to buy peace with the many instead of pandering to the few, but apparently not.
The OMA position is that primary care reform should not expand until the pilot sites have been thoroughly evaluated - a process that could take three years, according to the Toronto Star, and one that has not been implemented with any other radical reform undertaken by the Harris government.
Besides agreeing to the evaluation demand, the government is siding with the OMA to make rostering and the removal of fee-for-service voluntary for both patients and doctors. If it's voluntary, then there has to be an alternative. Does the term "two-tier health care" ring a bell?
This development must be profoundly disappointing to Ontarians who expected their government to tackle health care reform with the same vigor and determination they have brought to every other upheaval in the province's life. It's also frightening to all Canadians who worry about what is happening to our health care system. Privateers like Mike Harris and Alberta's Ralph Klein have taken hold of the reins while the federal government dithers over jurisdiction and financial control.
Pat Daley is a freelance writer and editor in Athlone in Simcoe County, Ontario.
Get More/Do More
You can see the Health Services Restructuring Commission's Seven Points for Action at www.hsrc-crss.org
Recommendations from the National Forum on Health are available at wwwnfh.hc-sc.gc.ca
Check out the Ontario Medical Association's policies at www.oma.org
Other articles from the Daley Dispatches
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