Ontario Doctors Strike Over Bill to Ban Fees Above Insurance Rates

At least 75% of the 15,000 doctors in Ontario, Canada’s largest and richest province, went on strike Thursday to protest legislation that would prohibit physicians from charging patients more than the fees set by the government medical insurance system.

Spokesmen for the Ontario Medical Assn., which called the two-day walkout, also said that nearly all non-essential surgery was postponed in the province’s 228 hospitals.

While doctors closed their offices and refused to carry out non-essential surgery, hospital emergency rooms remained open and physicians carried out normal visits to hospitalized patients. The strike did not seem to cause any serious problems, with hospitals generally reporting that emergency rooms were no busier than usual.

“I don’t think the patient flow was any greater than usual,” said Dr. Harold N. Fisher, head of emergency services at Toronto’s Mount Sinai Hospital. “Nobody’s complained to me about not being able to see their family doctor.”

Overbilling Charged

The walkout did not appear to weaken the government’s resolve to push ahead with its plans to stop what is called overbilling.

Ontario Health Minister Murray Elston told reporters that he could not fully assess the effects of the strike until Monday, but he said it was simply an effort “to pick extra money out of the patients’ pockets.”

Under Canadian federal law, any province that allows overbilling forfeits a dollar in government payments for every dollar that is charged over the insurance payment schedule. This year, Ontario is expected to lose up to $50 million in such transfer payments, which support nearly all of the provincial health systems.

According to the medical association president, Dr. Earl Meyer, the issue is not more money but freedom for private professionals to charge for their services.

“It is predictable that if the government captures the profession financially, it will find a way to intervene in the way we practice,” said Dr. Edward Moran, the association’s general secretary.

10% Overbill

Only 10% of the province’s doctors overbill, and all deny that they levy extra charges on patients who cannot afford the added costs.

However, the government argues that overbilling is the base for a two-tiered health system under which the rich receive better care.

The strike followed the breakdown of negotiations between the doctors and the government. The only concession that the doctors received was an indication that Elston was willing to modify plans to levy a $10,000 fine on any doctor who overbills.

That was not enough for the doctors. Meyer said nothing would do except withdrawal of the government legislation. He added that the two-day walkout will be followed by “more and stronger action.” He declined to detail what he meant, but added, “There is a great possibility that a walkout with no time limit will begin” shortly after a general meeting of the Ontario Medical Assn. on June 9.

Although 25% of the province’s doctors worked as usual, Toronto’s residents saw doctors standing outside subway stops, handing out pamphlets explaining their point of view. The medical association also set up an “accessibility center” on the lawn of the provincial legislature to urge public support.

However, the campaigning did not appear to be effective. Public opinion polls consistently show heavy support for the government, and an unofficial survey by the Global Television Network indicated that two-thirds of those responding opposed the doctors’ strike.

Nevertheless, even the overwhelming number of physicians who do not overbill backed the strike.

“I am certain that what we’re doing is right,” said Dr. Robert Henderson, chief of surgery at Women’s College Hospital. “It’s about time that an individual’s rights were protected.”

Dr. Irwin Walkoff, spokesman for the Committee of Concerned Psychiatrists, said: “We want to highlight the genuine barriers to accessibility which exist in the health care delivery system. This has nothing to do with physicians’ billing practices.”

On the average, Ontario’s doctors earn more than $130,000 a year and represent the highest-paid profession in Canada.