Government & Medicine

OMA to Mr Smitherman: Kill Bill 8

...or at least gut it. Did the ministry know what it was doing?
The physician association thinks not

By Hugh W Coulthart

Ontario's Future of Medicare Act (Bill 8) was tabled last November. It was designed to create a provincial Health Quality Council to monitor such things as access to health services and "health human resources," a catchall phrase principally aimed at doctors, nurses and hospital administrators. It also tightened the rules on extra-billing and so called queue-jumping and, for good measure, entrenched "accountability" that would establish agreements with healthcare providers tied to performance. Not surprisingly The Ontario Medical Association (OMA) hated the bill. They didn't like the contents and they didn't like the fact that they hadn't been consulted.

"When that bill landed, it went off like a hand grenade, because we didn't know it was coming," says OMA's Executive Director of Health Policy Dr Ted Boadway. "We were stunned by the aggressiveness of the bill itself. It was a pretty big surprise."

Perhaps because the government recognized, however belatedly, the need for knowledgeable input, they sent Bill 8 for review in committee hearings after the first reading instead of waiting, as is customary, until the second reading.

At the end of February, the OMA presented the committee with its assessment of the bill together with recommendations for amendments.

WHAT 'S IT ALL ABOUT, GEORGE?
On the guarantee of accessibility, the OMA argued that the bill would actually interfere with the provision of healthcare services in the province. Moreover, their brief suggested, its attempt to prohibit payments outside the Health Insurance Act, would outlaw 'sessional' payments to psychiatrists; for their participation in hospital and community mental health programs, payments to many hospital-based physicians; including laboratory physicians, and payments by private employers to occupational health physicians.

Perhaps the biggest guns were saved for the question of accessibility. The OMA told the hearings which ended February 26, that if implemented as is Bill 8 would bring chaos to the administration of Ontario's hospitals. The suggestion was that the involuntary agreements would give absolute power to the minister and expose health resource providers to such open-ended and arbitrary liability, that physicians would be compelled to withdraw from executive functions in the management of hospitals. Not to mention the most contentious issue, that the rules would apply to all practising physicians in the province.

A FEW SUGGESTIONS
Dr Boadway suggests the effect of the bill's accountability measures weren't fully appreciated by Health Minister George Smitherman until they were spelled out in the OMA presentation. "It became clear," he says, "that the Minister didn't really want to be all-powerful over all doctors in all those functions."

Since the hearings, the doctor has had the assurances from the ministry that physicians in solo and group practice will be excluded from "accountability agreements," but not that physicians in executive hospital functions will be excluded. "Until we actually have it in writing, we don't have it at all," says Dr Boadway. "So the minister's draft framework doesn't go far enough to prevent the damage."

Should the changes not be made, it's unclear exactly what the OMA might do to enforce it's view but it won't be pretty. "This has our attention, our very undivided attention," says the doctor. "This bill matters, and we know it, and we're not taking our focus off it for a second."