🚀 go-pugleaf

To my mind, this thread of articles has exposed at one major
misunderstanding, that the contentious fee cap on doctors' salaries
is an individual one that only affects the highest-billing doctors.

I don't dispute that the original bill did have this cap, but I
recall reading that its replacement does not (but I no longer have
the relevant newspapers to consult).  In any case, what is of greater
concern to doctors (as a whole), and consequently to the general
public, is the _global_ cap on billings.

With the global cap, the sum total of _all_ doctors' billings will
not be allowed to exceed some fixed amount.  Thus, to give concrete
(but fabricated) figures, if the cap is $1 billion, and during 1993,
doctors bill $1.2 billion to M.S.P., then Dr. X who billed $150,000
will only be paid for $125,000 of her billings.  (125 = 150 * 1/1.2)
Clearly, it is to Dr. X's advantage not to have worked all of the
time in the first place; I believe that many such doctors will
simply stop work if the global cap is reached, leading to a lower
overall level of service independent of actual medical need.

Unfortunately for doctors (and for the public, should my fears come
to pass), the global cap appears not to be negotiable.

One might worry too about the unilateral cancellation of the previous
agreement on medical services, something that smacks of dubious
ethics, or about "elimination of doctor/patient confidentiality
because of the government's new access to your personal medical files."
(This quote is straight from a B.C.M.A. advertisement.  Since the
B.C.M.A. is hardly a disinterested source, can anyone say exactly
what this means?  I only managed to find a single line on this subject
elsewhere in the papers.)

			*** *** 

Some further comments on Iain McVey's postings:

[ In connection with individual fee caps ]

>Would this not also encourage doctors to charge more per visit?

M.S.P. only pays according to the fee schedule; individual doctors
cannot dictate the rates they receive if they expect to be paid by
M.S.P.  Doctors working outside M.S.P. are, of course, free to set
whatever rates they choose, but then the issue of fee caps (whether
individual or global) becomes a non-issue for them.  (And, as Gary
Dare has noted, such doctors are few and far between.)  For the
sake of completeness, I'll point out that double billing, wherein
a doctor bills both patient and M.S.P., is not allowed.


>BC uses government funds to pay for a pension fund for our highest paid
>professionals, namely doctors.

This was cancelled with the rest of the previous agreement.  If you
were to ask me, I'd say that the worst pension culprits are our MPs --
they get them after serving single terms!


>What is it about the profession of medicine that makes people believe
>doctors should make so much of a better living than the people who pay
>for their services?

The degree of training and skill required?  The amount we value good
health?  And is it really that much better a living, compared with
other professions, accounting for labour and overhead?  Please note
that even if you can't justify doctors earning large amounts of money,
others can.  Egalitarianism and the _fact_ of free enterprise don't mix
well, so if B.C. is to maintain its health care system, it has to offer
its doctors wages that are comparable to what they could obtain elsewhere.


Lastly, I'd have to disagree with Iain about it being better to spend
health care funds on medical equipment.  I'd rather see it spent on
preventative care -- the old saying, "an ounce of prevention is worth
a pound of cure," is all too true.
-- 
Feng Chen
van-bc!mtnsys!feng		 feng@mtnsys.wimsey.bc.ca