Editorial: Two-tier health care is already here

For nearly a decade, Ontario’s doctors have been allowed to charge patients for services that were not paid for through OHIP. More recently, doctors offices have been more fastidious in collecting some fees for certain services. A growing trend within the medical community in Ontario has been to bundle certain services together as a package, and charge a yearly fee for these services.

Local residents who are patients of the St. Lawrence Medical Clinic began receiving letters offering one of these inclusive service plans. This plan covers uninsured services like telephone prescription renewals. Plans like these however also come at a high up-front cost – ranging from $99-$169. Without a service plan, patients can pay-as-you-go to have a prescription renewed without a doctors visit, or have forms completed. Or patients must book an appointment for a doctors visit. Bundled service plans fly in the face of the spirit of the Canadian health care system, and show that two-tier health care is indeed here already.

If you can afford to pay the fees, great for you. But some do not have the means. Service plans – or even pay-as-you-go fees – disproportionally discriminate against those who are without means. Convenient prescription renewals and forms for insurance companies may seem trivial, but it highlights the disparities in the system already. Those who can pay, get faster service and more convenient access. Those who do not have the means to pay, must wait in line. As more patients make appointments, it will create longer queues for clinic visits, and increase wait times in the health care system. OHIP will pay for renewals if there is a doctors visit, but not if there is no visit. By OHIP not allowing billing for certain services, it will do more damage to a system already filled with a significant backlog.

Are doctors wrong in wanting to be paid for certain services? No. Is this the right way to force the issue with the provincial government? The answer is also no. The Canada Health Act spells out that the national health care system must be universal, publicly administered, have comprehensive coverage, be portable across all provinces, and be accessible to the population.

Charging fees for essential services is inappropriate – especially when it create a second lane for people to bypass the system. The “haves” get better access to services, and the “have-nots” must wait in the queue that will grow ever longer.

The battle for covering uninsured fees is between the medical profession and Ontario’s Ministry of Health. The province has been unwilling to budge on paying human capital costs, all the while pumping billions into building physical capital like buildings. Doctors are also less than willing to compromise as it is their livelihood. While these parties remain at loggerheads, it is Ontarians who will continue to see our two-tier health care system expand further.

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