HEALTH CARE - User fees

pfezziwig

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Mar 24, 2009
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Free Public Universal Healthcare?

Funny how we call our public healthcare system free and universal.

People are discouraged by lengthy wait times to see specialists and people are discouraged from taking prescriptions they cannot afford and the quality of care ranks slightly ahead of other third world coutries.

We cover less and less and add more and more small fees, is this our solution for a sustainable free and universal public healthcare system? The cherry on the cake is many Canadians are hell bent against private healthcare too.

Can't wait to see what our healthcare system is like in 10 years, i'm sure there will be fewer fees and shorter wait times by keeping private healthcare out of canada, great plan canada !
 

SirJosephPorter

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Nov 7, 2008
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Absolutely but that doesn't preclude the feasibility of "user fees" for the financially able as I've been trying to get through our resident Liberal accolade's head.

It doesn’t preclude anything JLM, as a country we may do as we wish. However, user fee will be totally counterproductive, as I have demonstrated here. It won’t lead to less health care cost; it will lead to more (on account of people not getting preventive care). It will also lead to deterioration of the health of the population in general.

I am not opposed to user fee on principle, I am opposed to it because it doesn’t work, it is counterproductive.
 

VanIsle

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Nov 12, 2008
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I know a doctor who closed her practice. By law, she is required to keep charts for 7 years, or in the case of a baby born under her care, until the baby turns 21. So every single chart that was transferred had to be photocopied, one page at at time. This required her to rent a photocopier and hire a part time employee for a month.

I have no idea why she charged the patients for this, I guess it should have been done for free.

That's why doctors charge to transfer your records: because it costs them time and money.
Lots of doctors close their practice either because of retirement, new location, or self illness. They are required to store those files. There is no requirement to copy them.
Doctors must keep them for seven years but for some odd reason, Chiropractors must keep them for as long as the patient is alive. (I don't know what has to happen should the Chiropractor pass on.)
 

SirJosephPorter

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I don't believe in grown, able adults being babied, especially by Gov.'t. If a person is infirm physically or mentally or is destitute for good reason then there is assistance available to him from several sources- the Gov't. , the Salvation Army, just to name a couple. I doubt if any medical provider demands payment on the spot, where the condition is life or limb threatening, arrangements can be made to pay at the end of the month. With one third of the population supporting the other 2/3, people have to start taking charge of their own affairs. As long as parasites are allowed to keep being parasites, the problem will never improve. I don't know if that is Conservative thinking or Liberal thinking but I'm sure it's sensible thinking. I don't require a response from any "Liberal Accolytes". :lol::lol::lol:

And how is user fee going to solve any of these problems? And user fee by definition means that payment is made on the spot. And what arrangement do you propose should be made to pay at the end of the month? Is the doctor supposed to take patient's word for it? The doctor will be lucky to recover half the money at the end of the month. Doctor may have to start acting as a collection agency, and most doctors will resent that deeply.
 

AnnaG

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Jul 5, 2009
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User fees were already tried in this province and it just didn't work. Now would be worse than any other time. The grocery stores are dead. If you think people will pay for a check up they are not sure they need - you would be dead wrong. It cost the doctors more to collect user fees than it does to charge them and that they receive for charging them. People promise to pay and doctors cannot refuse to give treatment in an emergency so they never get the fees anyway. Doctors never used to charge for transferring a medical file but they do now. The cost is $35.00 to email your records across town!
Funny. I don't remember reading anything about health care collapses because of user fees. Do you have any links showing user fees being such a disaster?
Stores aren't dead around here.
People around here, for the most part are fairly health conscious. Most see their docs for regular checkups and would find $20 a year for the checkup.
If it would cost docs more to collect user fees than it'd be worth, how does my eye doc get away with it? Before when hubby was covered for dental, how did our dentist get away with it? Why aren't they broke? If my doc charged a $20 per visit, she'd be raking in around $500 a day and you think it'd cost her more to collect than that $500? lol That's hilarious.
How much do docs transfer files around? I've had a sum total of 3 docs in my life. That's 3 transfers. My doctors must have gone broke from sending my file around.
 

SirJosephPorter

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Nov 7, 2008
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User fees has some validity since it will offset the cost we pay in our taxes for health care. of course, any saving we might make wont be credited to us so, while our taxes will remain, we will now have to spend money as well as pay the same amount of tax.

You are getting the idea. If there are user fees, we will continue paying the same amount of tax. Doctors will keep earning the same amount of money, government will pocket the extra money. Government will simply deduct from doctor's payment the amount of user fee.

I personally am a believer in allowing people who can to pay for service.
But isn't that what happens now? Health case is financed from income taxes, so those who can afford, pay more than those who cannot.
 

VanIsle

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Nov 12, 2008
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Here's the scoop. They are YOUR files not your doctor's. If you want copies do it yourself.
Ask a doctor to hand over your file so you can copy it then! It won't happen. I tried to have my file given to me. I had to argue with the doctors office to get it. They wanted to send it directly to my new doctors office for a fee of $35.00. I told them that under the freedom of information act, I had the right to my own file. They then gave in to a time when I could pick up my file - for $35.00. They copied it for me and vetted some of the doctors words and included a snotagram stating I had cited that I was entitled to my own file under the Freedom of Information Act. It was quite an un-pleasant experience along with the part where the doctor 1. Chose to vet some of his words and 2. was less than truthful about one office visit I had with him.
 

SirJosephPorter

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Nov 7, 2008
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I'm all for user fees if you go to ER with a cough or stubbed toe. If you are bleeding profusly or are unconscious then ER is the place for you otherwise the clinic down the street is more than equiped with x-rays and a treatment room capable of anything short of a stabbing.

But there is a problem here. Who decides if the illness was minor enough to be eligible for user fee? Does the receptionist at the ER decide that? Does the doctor decide that? If it is the doctor, is he going to get paid extra to decide that? He most certainly will expect extra payment for the extra work.

Charging user fee in ER makes a bit more sense than charging user fee in doctor's office, in that it won't discourage the patient from going for preventive health care. But there are problems here as well. But the problems are not insurmountable, user fee in ER may be worth considering.
 

SirJosephPorter

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User fees were already tried in this province and it just didn't work. Now would be worse than any other time. The grocery stores are dead. If you think people will pay for a check up they are not sure they need - you would be dead wrong. It cost the doctors more to collect user fees than it does to charge them and that they receive for charging them. People promise to pay and doctors cannot refuse to give treatment in an emergency so they never get the fees anyway. Doctors never used to charge for transferring a medical file but they do now. The cost is $35.00 to email your records across town!

So user fee was tried in BC and it didn’t work. Now, why doesn’t that surprise me? And you are right, if it is left to the doctors to collect user fee, he will be lucky if he can collect half of it. That is why he will resent the added responsibility of collecting the user fee, especially if he is not getting any cut of it.

As to transferring of the chart, you are right, doctors do charge for it these days. They also charge for all kinds of third party services not covered by OHIP, such as sick note, driver’s medical exam for employment etc. In these cases, it is payment up front. If you don’t pay, you don’t get the sick note. But you can’t do that when treating a patient.
 

SirJosephPorter

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Nov 7, 2008
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"Doctors never used to charge for transferring a medical file but they do now. The cost is $35.00 to email your records across town!"

Not in all cases- I had mine transferred from Christina Lake to Vernon- No charge. I just had to sign a paper giving the doc in C.L. the authority to release them.

Depends upon the doctor, JLM. Most of them do charge these days. Certainly my wife does. Unless she throws out the patient, then she will do it for free.
 

AnnaG

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Jul 5, 2009
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"My point is that we as a society seem to have forgotten we can heal without a doctors touch."

Absolutely right- there was an interesting article in Readers' Digest about 10 years ago pointing out that about 95% of our ailments will heal themselves without having to see the doctor and by the same token a high percentage of the ones that are life threatening he /she can't do much about anyway. Guess a lot depends on how effective your immune system is. A lot of it has to do with mind over matter, people who think they are sick generally are and people who think they are going to get better generally do. A lot of times getting out for some strenuous exercise does you more good than going to the doc. I think that is because oxygen is the one commodity the body depends on more than anything else and exercise is a sure way to ensure the body is getting lots of it.
A lot of it has to do with the foods people eat, too.

In 2005 cardiovascular disease accounted for:

  • 31% of all deaths in Canada (71,338 deaths – or more than 71,000)
  • 30% of all male deaths
  • 31% of all female deaths
In 2005, of all cardiovascular deaths:

  • 54% were due to ischemic heart disease
  • 20% to stroke
  • 24% to heart attack
Heart disease and stroke costs the Canadian economy more than $22.2 billion every year in physician services, hospital costs, lost wages and decreased productivity.
(Canadian Heart & Stroke Foundation statistics).

That is due to diabetes, smoking, diet, lack of exercise, alcohol overconsumption, and stress mostly. About 2% is due to congenital defect.

Something like one 6th of Canadians will develop heart disease unnecessarily. People that abuse themselves that badly deserve to pay.
 

SirJosephPorter

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Nov 7, 2008
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That's because the doctors are not required to charge, the can choose to. Most do now (to their dis-credit in my view)

There is no discredit here. It takes doctor some time to get the chart together, make sure it is complete and mail it to the other doctor. Surely doctor's time is worth something?
 

AnnaG

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Jul 5, 2009
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Not to mention being outside can bring natural vitamins to improve out health. However, for the most part I have been fairly healthy and was brought up to use the doctors as a last option. That way I can avoid busy contagious waiting rooms as well as leave space for those who need the appointment time.

So, maybe user fees will reduce the number of hangnail cases but the downside is it will alter Canadian Healthcare and change it into a system which further alienates those less fortunate. Government support for the poor is not an easy process for the honest as it is. I wold hate to see healthcare financial support become thought of as our welfare, disability or social housing systems. I would hate to see the middle class choose to remain infectious because sparing the funds for an appointment would lead to undue hardship on that family unit.

Sorry, Just my rant
I am sure it would cost the gov'ts less even if they had to fork over for those that could not pay user fees. There's a way around the problem of poor people. All it takes is a little thought.
 

SirJosephPorter

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Nov 7, 2008
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I know a doctor who closed her practice. By law, she is required to keep charts for 7 years, or in the case of a baby born under her care, until the baby turns 21. So every single chart that was transferred had to be photocopied, one page at at time. This required her to rent a photocopier and hire a part time employee for a month.

I have no idea why she charged the patients for this, I guess it should have been done for free.

That's why doctors charge to transfer your records: because it costs them time and money.

That 7 year rules applies to all doctors, not only those who have closed the practice. So if my wife has to send the chart, she also sends a photocopy, and not the original. As I mentioned in my previous post, there are costs associated with transferring of charts, and it is only appropriate that the patient pays for it.
 

SirJosephPorter

Time Out
Nov 7, 2008
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"My point is that we as a society seem to have forgotten we can heal without a doctors touch."

Absolutely right- there was an interesting article in Readers' Digest about 10 years ago pointing out that about 95% of our ailments will heal themselves without having to see the doctor and by the same token a high percentage of the ones that are life threatening he /she can't do much about anyway. .

Then I guess there is no need for doctors. Then what is the fuss all about?
 

Avro

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Feb 12, 2007
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User fees are a dumb idea opening the door for cost sucking administration expenses.....just look south for that example.
 

AnnaG

Hall of Fame Member
Jul 5, 2009
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Funny how we call our public healthcare system free and universal.

People are discouraged by lengthy wait times to see specialists and people are discouraged from taking prescriptions they cannot afford and the quality of care ranks slightly ahead of other third world coutries.

We cover less and less and add more and more small fees, is this our solution for a sustainable free and universal public healthcare system? The cherry on the cake is many Canadians are hell bent against private healthcare too.

Can't wait to see what our healthcare system is like in 10 years, i'm sure there will be fewer fees and shorter wait times by keeping private healthcare out of canada, great plan canada !
The last I heard, the projection was that unless something changes, our health care system will be using up 70 to 75% of our gov'ts budgets by around 2025. That is unsustainable.
 

VanIsle

Always thinking
Nov 12, 2008
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48
Funny. I don't remember reading anything about health care collapses because of user fees. Do you have any links showing user fees being such a disaster?
Stores aren't dead around here.
People around here, for the most part are fairly health conscious. Most see their docs for regular checkups and would find $20 a year for the checkup.
If it would cost docs more to collect user fees than it'd be worth, how does my eye doc get away with it? Before when hubby was covered for dental, how did our dentist get away with it? Why aren't they broke? If my doc charged a $20 per visit, she'd be raking in around $500 a day and you think it'd cost her more to collect than that $500? lol That's hilarious.
How much do docs transfer files around? I've had a sum total of 3 docs in my life. That's 3 transfers. My doctors must have gone broke from sending my file around.
It was years and years ago that doctors started charging a $5.00 user fee for every visit. There were so many complaints that it ended and our own doctor of the time stated that it was simply not worth the time and effort.
How does your eye doctor get to charge? That's pretty easy. The government no longer pays any part of your visit to your eye doctor until you are age 65+ just like they no longer pay for a visit to Physiotherapists, Chiropractors, Podiatrists, and Naturopaths. Without a "user" fee, these services would be gone completely. It's not actually a user fee, it's just a fee. I believe my last eye exam was $95.00. (or 85).
Stores might not be dead where you are but they are dying here. I'm talking about larger stores like grocery stores the size of Save On More/ Costco etc. Our store has been slow for months with Christmas being the exception. I had a customer yesterday who said he had just come from Costco and it was dead in there too. Now today is Friday and all stores will pick up for the day but the store I work at was "Friday" busy everyday. The addition of 6 self-serve tills has driven customers away in droves. Along with the complaints we get regarding our own we also hear about the ones they don't like at Canadian Tire and at Home Depot. The store was so busy a couple of weeks ago and since we have been slow, not enough cashiers were on duty to cover all the tills. It appears this is done in order to force people to use the self scans where six tills are watched over by one cashier. Out of frustration, people started throwing things at the poor cashier that was overseeing self scan purchases. The self scans and our large open doors are like an invitation to steal all you can and people do. We have a wider opening than Costco does for people entering and leaving the store and no one watches those doors for carts and carts full of groceries leaving the store. Naturally, profits are down. It's a wonderful way of switching the store to a non-union store.
Dentists are not covered by any govenment plan and do not have a user fee either. They just have a fee. If you are lucky enough to be on a dental plan you get a break but if you are not - you pay the full fee. Dentists have never been on any government health plan.
Doctors do charge about $20.00 per visit - to the government and that's why we pay a monthly fee for health care. You really should find out more about how your health care is funded (or not).
I've lived in many towns and cities in this province and had my medical file transferred everytime. The only time I paid was for the one I picked up myself but upon phoning to ask them to transfer my file, I was informed of the fee (less than a year ago) and I had to pay that fee even though I picked the file up myself. I inquired about it a few years ago when a Vernon doctor sent me a bill for transferring my file to this city. I was informed at the time that while the charge (ability to charge) has always been there, most doctors choose not to use it. Time changes all things.
 

SirJosephPorter

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Nov 7, 2008
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Here's the scoop. They are YOUR files not your doctor's. If you want copies do it yourself.

They are NOT your files, they belong to the doctor. That is why you cannot have the originals. If the College, OHIP or anybody asks for the chart, the doctor must be able to produce it (and produce the originals, not the photocopies). Since the chart is about you, you have the right to know what is in it. But you can only have photocopies and you must pay a fee for it (as laid down by Ontario Medical association).

A few years ago one of my wife's patient died of some disease. After her death, her husband requested her chart. I don't know if he was going on a fishing expedition with a view of suing the doctor.

Anyway, my wife explained in a letter to him that she cannot give him the chart, by law she is required to keep it. However, he may have photocopies, but he will have to pay photocopying fee for it.

But the patient had a huge chart. According to OMA guidelines (and she attached a copy of the guidelines), the photocopying bill came to several hundred dollars. She explained to the husband that as soon as she receives the payment, she will send him the chart.

She never heard from him again.