Good read on Canada's efforts to cap doctor fees

[MacGyver]

http://www.lib.unb.ca/Texts/CJRS/bin/get.cgi?directory=Spring97/grant/&filename=Grant.html

OK, so this link is a little dated, but it gives great insight into how socialized medicine WILL squeeze doctors incomes down.

Note that there are 2 primary facets to this that screw doctors over in such a system:

1) Govt has a "take it or leave it" attitude. They have all the leverage in negotiating doctor incomes; threats of doctor strikes dont work because of #2

2) Govt can and will use the threat of opening the floodgates to foreign doctors to stifle any demands that docs place on reimbursement. Note that Saskatchewan, instead of paying doctors more relative to the other provinces, basically said "screw you" to the doctors and decided to open the floodgates to FMGs instead. As a result, there are more FMGs in Saskatchewan than native born canadian docs. That wasnt always the case, I suppose immigration advocates will now use that to conclude that foreigners do the jobs that "natives dont want to do"

Here are some key excerpts:

The early 1990s, however, marked a shift in public health care expenditures. With the widespread preoccupation of provincial governments with deficit reduction, and with the general failure of user-fees and other demand-side initiatives, the number and earnings of physicians became the target of various "cost containment" measures.(1) Provincial initiatives sought to address the fees, incomes, and number/location of physicians:

• Fee schedules. Negotiations between the province's government and its medical association over fee-for-service payments became more "one-sided" with some governments choosing a "take it or leave it approach" or unilaterally imposing fee schedules (Deber et al 1994). The general result was a much slower rate of growth in fees.

• Utilization rates. Several provinces (New Brunswick, Newfoundland, Quebec) placed absolute "caps" on their overall health care budgets or total payments to physicians. Others (Ontario, British Columbia) limited individual physician incomes and/or the rate of increase in aggregate physicians billings. By 1992, all six provinces east of Manitoba began experimenting with "nonlinear" compensation schemes for physicians wherein practitioners billing above a certain threshold received only a percentage of the normal fee. The strictest limitations were imposed in Quebec, where general practitioners receive only 25 per cent of their annual billings above a threshold of $180,000 (Ferrall et al 1998).

The impact of these initiatives on the income of physicians became apparent by 1993. Figure 1 displays the mean pre-income tax, net professional earnings (expressed in 1995 constant dollars) of all self-employed physicians between 1981 and 1995. After suffering a substantial erosion in real earnings during the 1970s, Canadian physicians enjoyed a steady improvement in average income from $109,471 in 1981 to $126,322 in 1992. But in the subsequent three years, real earnings fell substantially such that by 1995 most of the gains physicians had made during the 1980s were dissipated.

The reason this link is so interesting is because it is a CARBON COPY of what will happen in the USA once "universal healthcare" wins over.

In a govt controlled healthcare system, doctors have no leverage because there are millions of FMGs that the govt can easily tap into.

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[LADoc00]

http://www.lib.unb.ca/Texts/CJRS/bin/get.cgi?directory=Spring97/grant/&filename=Grant.html

OK, so this link is a little dated, but it gives great insight into how socialized medicine WILL squeeze doctors incomes down.

Note that there are 2 primary facets to this that screw doctors over in such a system:

1) Govt has a "take it or leave it" attitude. They have all the leverage in negotiating doctor incomes; threats of doctor strikes dont work because of #2

2) Govt can and will use the threat of opening the floodgates to foreign doctors to stifle any demands that docs place on reimbursement. Note that Saskatchewan, instead of paying doctors more relative to the other provinces, basically said "screw you" to the doctors and decided to open the floodgates to FMGs instead. As a result, there are more FMGs in Saskatchewan than native born canadian docs. That wasnt always the case, I suppose immigration advocates will now use that to conclude that foreigners do the jobs that "natives dont want to do"

Here are some key excerpts:







The reason this link is so interesting is because it is a CARBON COPY of what will happen in the USA once "universal healthcare" wins over.

In a govt controlled healthcare system, doctors have no leverage because there are millions of FMGs that the govt can easily tap into.

As governor of California I will ban ALL FMGs from medical licensure unless they repeat the US medical curriculum at an approved ACGME school. End of story.

Vote for LADOC and END this nonsense.

 

[chef_NU]

http://www.lib.unb.ca/Texts/CJRS/bin/get.cgi?directory=Spring97/grant/&filename=Grant.html

2) Govt can and will use the threat of opening the floodgates to foreign doctors to stifle any demands that docs place on reimbursement. Note that Saskatchewan, instead of paying doctors more relative to the other provinces, basically said "screw you" to the doctors and decided to open the floodgates to FMGs instead. As a result, there are more FMGs in Saskatchewan than native born canadian docs. That wasnt always the case, I suppose immigration advocates will now use that to conclude that foreigners do the jobs that "natives dont want to do"

What's wrong with this happening? If FMGs can do the job as well as an American doc for less money, why shouldn't they be able to put the American out of business? Your second "concern" isn't a concern about threats of a pro-socialism-in-medicine government, its a concern about protectionism not being there to save your butt from competition.

 

[akinf]

Canada is having a serious problem with health care issues right now, and part of it stems from when universal health care was first instituted. It worked really well for everyone, but as technology as advanced, demands on physicians have increased, policy has not changed. In times like this where advancing technology is actually requires more money into health care (whereas in other industries requires less) it is important to find the resources to account for this. Having a two-tier system in which people can go to private facilities if the public sector cannot provide it is fine. For those who want to pay, they can just go straight to the private. It would decrease wait-times substantially, and it wouldn't really mean anyone's life was more important than another. In this scheme, I think it would be important to offer certain governments benefits (like excellent pention plans and guaranteed vacation time) to physicians to ensure that working conditions and delivery of health care is at a quality standard. There are more issues than the one I mentioned, but I think this is one that is sometimes over-looked.

 

[aamartin81]

The main reason this will not happen in the US anytime soon is simply monetary. The top health insurers profited over $10 Billion last year. That's quite a large lobbying group. Do you think they are going to hand over that money without exhausting the appeals process? Another reason to consider: are lawmakers who currently enjoy the private system of healthcare likely to volunteer to get in line behind criminals and people who choose not to work or those who can afford some type of insurance but do not purchase it?

Just some questions to think about.

 

[Solideliquid]

As governor of California I will ban ALL FMGs from medical licensure unless they repeat the US medical curriculum at an approved ACGME school. End of story.

Vote for LADOC and END this nonsense.

All along I thought you were an IMG.