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History: 19781988 FROM COST CONTROL TO HEALTH PROMOTION: IMPLEMENTING MEDICARE, 19681978 SAVING THE SYSTEM: THE CANADA HEALTH ACT, THE OTTAWA CHARTER AND ACHIEVING HEALTH FOR ALL, 19781988 THE ENDLESS CHALLENGE: BALANCING CHANGE AND CONTINUITY, 19892007



Conflict and Conciliation

When the Canada Health Act came into effect on July 1, 1984, all provinces knew they had three years to negotiate an end to extra-billing and user fees if they wished to be reimbursed for accumulated funds being withheld at the federal level, as penalties for those practices, under the Act's dollar-for-dollar restriction. British Columbia and Quebec had already outlawed extra-billing and Nova Scotia quickly followed suit. In Saskatchewan, where Mode III or extra-billing had been allowed under the Saskatoon Agreement that ended the 1962 doctors’ strike, the medical association claimed that maintaining this right “is extremely important for the profession’s freedom . . . [because it] is the single factor that separates the medical profession from being legislated into a civil service, union-like position” (Health Insurance and Canadian Public Policy, p. 448). The provincial government, however, resolved the matter by creating a new medical compensation review committee that would make negotiating the fee schedule a joint profession–government activity; in return, the Saskatchewan Medical Association agreed to have extra-billing banned, although doctors could still opt out of the provincial plan.

In Manitoba, the government had assumed that extra-billing was a minor concern, but when the reporting provisions of the Canada Health Act were applied, it discovered that 95 per cent of opted-out doctors were extra-billing, some as much as 80 per cent above provincial fee levels. This hurt seniors in particular and led the Minister of Health, Larry Desjardins, to bring in legislation that provided for binding arbitration and ended extra-billing. Wisely, he negotiated with the Manitoba Medical Association in order to counter the animosity of the specialists in the Association of Independent Physicians. When the legislation went into effect on August 1, 1985, 86 per cent of the province’s doctors supported it, and the federal government paid Manitoba the $1.27 million that had accumulated as a result of extra-billing.

Photo: What are the side effects doctor? Pain ... Pure unadulterated pain! (Fund cutbacks)
What are the side effects doctor? Pain ... Pure unadulterated pain! (Fund cutbacks)

In this 1983 cartoon, Tom Innes reveals the painful consequences for the provinces that delayed ending extra billing and user fees when the Canada Health Act came into effect.
Glenbow Archives, M-8000-1297



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    Date Created: March 31, 2010 | Last Updated: April 21, 2010