Doctor Dilemma

Doctor Dilemma: Public Policy and the Changing Role of Physicians Under Ontario Medicare

Copyright Date: 1999
Pages: 159
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  • Book Info
    Doctor Dilemma
    Book Description:

    The Doctor Dilemma provides a timely discussion of policy issues in five key areas of physician-related public policy in Ontario: physician payment schemes, regulation of physician numbers and distribution, monitoring of the quality of medical care, the role of physicians in hospitals, and the regulation of new medical technologies. Shortt defines the scope of the problems, clarifies the focus of the debate, identifies the constraints on policy formation, and discusses the policy options available.

    eISBN: 978-0-7735-6749-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-2)
  4. Introduction
    (pp. 3-8)

    In the winter of 1996 a physician in Burlington, Ontario, became concerned about the mental status of two individuals. One, a middle-aged male, had apparently developed a monotone style of speech, displayed little facial expression, and engaged in inappropriate behaviour. The presence of a thought disorder or psychosis could not be ruled out. Indeed, stated the physician, the actions of both individuals were possibly dangerous to themselves and were clearly a hazard to others. On that basis he completed paperwork which, under the Mental Health Act, requires police to apprehend the named individuals for the purpose of a compulsory psychiatric...

  5. 1 Context: Reform since 1985
    (pp. 9-19)

    The system of medicare created for Canada in 1966 has enjoyed unquestionable success. On conventional measurements such as life expectancy and perinatal mortality rates, Canada ranks close to the top among developed nations. When compared on more specific grounds with its traditional rival and neighbour, the United States, Canada’s publicly financed, universal-coverage system frequently produces roughly comparable outcomes, more equitably distributed. Consider the example of cardiovascular disease. The treatment of myocardial infarction in Canada has been shown to rely markedly less than the United States on coronary care units and invasive procedures, yet both mortality rates and re-infarction rates are...

  6. 2 Paying the Piper: The Fee-for-Service System and Its Alternatives
    (pp. 20-38)

    Canada’s health care system combines its own traditional entrepreneurial fee-for-service format with the type of state-funded, universal-access system more characteristic of European nations. While it is doubtful that any health planner would deliberately set out to create such a hybrid system it is none the less the way things have evolved in Canada: private entrepreneurialism in symbiosis with public altruism. It is a system that puzzles US observers, whose responses have recently ranged from enthusiastic¹ to dismissive² and displayed highly divergent levels of knowledge and mythology,³ often reflecting little more than the employment affiliation of the commentators. At home the...

  7. 3 How Many Pipers? The Supply and Distribution of Physicians
    (pp. 39-53)

    James Henry, an Ontario physician active in medical politics, expressed the following views in a letter to a medical journal: “It must be apparent to every medical man in the province that the profession is becoming fearfully filled; that the number ... entering upon the study of medicine is greatly in excess of the wants or requirements of this young country.”¹ The year was 1888, and Henry was expressing the traditional opinion of established practitioners competing with new graduates in recessionary times. Almost a century later a health economist considered the same issue in the following terms: “Because of the...

  8. 4 Calling the Tune: Quality Assessment and Assurance in Ambulatory Care
    (pp. 54-66)

    Each month the Ontario Health Insurance Plan (OHIP) processes in excess of ten million claims. A large proportion of these are submitted by physicians for “ambulatory care encounters” - patients’ visits to a doctor. The individual claim identifies the patient, the physician, the principal diagnosis, and the fee code for the service. Barring an administrative anomaly such as an incorrect numbers for the patient health card, the claim is generally paid without further inquiry. From that moment on, the encounter ceases to interest the Ministry of Health other than in its role as one minute contribution to the ever-increasing expenditures...

  9. 5 Restructuring the Pipers’ Workshop: Physicians in Hospitals
    (pp. 67-79)

    Within the hospital, a familiar institution in the Canadian social landscape, no figure is more clearly visible than the physician. Indeed, the hospital has often been referred to as “the doctors’ workshop.” Yet this is a misleading metaphor. Unlike the artisan in his or her workshop, the hospital doctor pays no rent, hires no staff, buys no raw materials, owns no tools or equipment, and is guaranteed full payment by the state for whatever services are rendered, regardless of outcome. The failure of the workshop metaphor, in fact, points to the central anomaly of the physicians’ role in the hospital...

  10. 6 The Pied Piper of Technology?
    (pp. 80-97)

    Technology is the medical profession’s touchstone, a form of tangible substantiation for the physician’s claim to pre-eminence within the health care system. But for many professionals, including health economists, policy analysts, and biomedical engineers, the role of technology is far more problematic. Following a brief introduction to the evolution of technology in medicine, this chapter discusses the dilemma posed by technology under three broad headings - specific aspects of medical technology that occasion problems; major constraints on effective action to resolve these concerns; and tentative suggestions as to appropriate policy initiatives for managing technology. Physicians, it will be seen, are...

  11. Conclusion
    (pp. 98-106)

    The year following the buffoonery of the Burlington physician described in the introduction was not a pleasant one for Ontario’s minister of health. In the midst of a bitter dispute with physicians, complete with the selective withdrawal of medical services, he was forced to step aside by the public indiscretions of an aide. Months later, after he was exonerated and reinstated in his post, his return to the legislature was blighted by a most unusual event. An opposition member sponsored a resolution condemning the Conservative government’s health policy, normally a relatively innocuous parliamentary tactic. On this occasion, however, six government...

  12. Notes
    (pp. 107-142)
  13. A Note on Sources
    (pp. 143-146)
  14. Index
    (pp. 147-148)