By a narrow margin (50 to 48) the Canadian Medical Association has for now rejected medical user- fees.

Doctors against user-fees argued that fees collected from patients at the time they visit doctors and hospitals diminish access to the medical system. While such fees decrease unnecessary visits e.g. to hospital emergency wards, they disproportionately effect patients with fewer resources.

Those in favour of medical fees argued that patients should help fund their own care with « co-payments and health savings accounts. » These accounts would act like registered retirement savings plans, enabling people to stash savings in tax sheltered accounts, to be spent on medical items like home care, long-term care and prescription drugs. Also it was pointed out that budget restraints mean new medical technologies and the latest drugs are not covered by provincial governments.

Should Canadians be allowed to save for their retirement and for education in tax-sheltered plans, but not for health care?

Do you support some kind of medical user-fees?



  1. 1
    Cate McB Says:

    I think the question is, why should Canadians have to SAVE for their health care when we already have a system whereby our tax dollars should be supporting the system adequately. You don’t need rocket science to conclude that a group plan is cheaper than an individual plan, and if the system is not being supported adequately by our current tax dollars (and many would argue that it’s not), then we have to ask ourselves how our money is being spent and whether or not it’s being spent wisely. The problem is that to a great degree, it’s being spent in the wrong places, e.g., on a fee-for-service system that creates doctor-entrepreneurs and doesn’t ask whether we really need all the services that doctors perform, and on an administrative system that has grown exponentially to the detriment of patient care, for example, there’s a need to study how CEO’s actually function within healthcare, how much money CEO’s make, and how their bonus system works before we start asking Canadians to SAVE more for health care. In many cases, nurses and pharmacists are doing and could be doing more of physician work and these are cheaper and more effective care givers. I strongly believe that the white coats are holding us for ransom here and we need to rise up against it like we do against other obvious injustices. But the problem is that many average folks don’t want to know and don’t have any day-to-day reasons to know how healthcare (especially our hospitals and physicians) actually function. Whether or not you usually like Michael Moore’s films, go and see SICKO and then plant yourself in the waiting room of a few hospitals around the world (a good start anyways!) and see for yourself whether he’s right. As a nurse and a clinical ethicist working within the system, I already know that he’s portraying what’s real in a way that I recognize, and I think we need to fight to the death literally for a system that works for everyone, not just for the rich.

  2. 2
    Cate McB Says:

    If you want more info, check out the web site of the Canadian Health Coalition:
    See especially their brochure entitled, « We Can’t Afford Private Health Care. »

  3. 3
    Cate McB Says:

    P.S. #2
    You might also want to check out the web site of the Canadian Doctors for Medicare:

    Don’t miss their Board of Directors.

  4. 4
    jim Says:

    Somethings up. The CMA 2 years ago voted 2 to 1 in favour of dual medicine. 1 year ago they elected themselves a President who owned a private clinic. Now they are just about evenly split in in favour of medicare. Doctors are almost at the top of the list for being money hungry. So what’s up? Other observations – Harper’s minister of health looking into the pharmaceutical business was found to have owned shares in a pharma company. – Over 100,000 people died in hospitals in Canada last year. Wouldn’t there be a major jump in deaths if cases were handled in the private sector which wouldn’t have the facilities the public hospitals do. What really bothers me is that most Canadians cannot travel abroad because the system provides very little sickness coverage and most cannot afford travel insurance and are prisoners of the snow belt. Jim

  5. 5

    Cate – I agree whole heartedly about Sicko. It’s a dreadful indictment of the U.S. system. On user fees I just thought they might, in specialized areas, cut down on the exploitation of the system that is over-burdened to begin with. For example, if you established a five dollar fee for use of the emergency ward, I think it might reduce the number of people who don’t need to be there in the first place.

    Jim – It seems to me that those who can afford to travel abroad should be able to afford travel insurance. If not, I guess, as you say, they’ll have to vacation in the Laurentians.

  6. 6
    Cate McB Says:


    I would challenge you to visit your neighbourhood Emergency Dept. for a few hours and see who is there and why they’re there.

    Some examples you might see: folks who are there because they don’t have a family doctor or they can’t get in soon enough to see their swamped family doctor. Why don’t they have a family doctor? Because there’s such a shortage & family medicine doesn’t excite and/or doesn’t pay enough in the eyes of the new recruits. Then there’s the people who have chronic conditions/pain for which the medical system either doesn’t provide adequate services in most venues or doesn’t provide adequate services period. Then there’s older people, some of whom can’t get a family doctor, not just because of the shortage, but because the family doctor they may have inquired about won’t take seniors period. Then there’s the people who are there because of the effects of lifestyle issues, eg., smoking, drinking, eating, depression, etc. The problem here — the medical system doesn’t do prevention for the most part, nor does it let in enough access for professionals who do it much better, e.g., nurse practitioners, « alternative » medicine practitioners, etc. Then there’s the parents and kids who come to ER. The problem here — again, not enough access to family doctors, but in addition, a shortage of pediatricians in Canada. Why? Again, I suspect its because pediatrics is not sexy enough, nor does it pay enough with good enough hours for the new recruits. Then there’s the poor who come to ER. The problems in this area I can’t possibly cover here but at base, they literally have nowhere else to go in most situations. I would suspect that in fact, there are very few who are in the ER who don’t need to be there in the first place. The wait itself often deters those who have low-priority needs from staying. And if the issue is that some can afford to pay more, why don’t we offer those folks the chance to pay more at tax time so that the entire system can be supported for the good of all? Also, again, I think there is a need to connect fees with the authentic needs of the population, not with needs that physicians find particularly sexy like the perceived « need » for stem cells, etc.

  7. 7
    Barbara Says:

    You go, Cate!

    It may not be politically correct, but the increased number of women physicians as well as the cultural difference between generations has probably seen doctors working fewer hours per week. I have even heard it said that it is one of the perks of the profession that you can essentially decide how many hours of work you want to put in per week.
    I would like to see a « price tag » associated with a « permanent » medical license requiring practictioners to put in a certain number of years as a family physician or pediatrician.
    They need not be consecutive years, if establishing a family is a priority at one point. However, a « provisional » license would expire after a certain period.
    Simultaneously, more places could be opened in medical schools and scholarships offered to those who decide to become family physicians and agree to putting in additional years into that practice.
    That’s off the top of my head, so there may be problems I am not seeing.

  8. 8

    Barbara – Its certainly worth thinking about but regimenting doctors can be a tricky business. I rmember Quebec tried to force doctors to spend a year or two in rural areas. I believe many of them finished their training and left the province.

  9. 9
    Cate McB Says:

    I have worked in and still sometimes work in the ER so all my examples of who is there and why they are there come from direct personal experience. My point is that if more people actually observed, experienced and reflected upon what is going on in health care, then we could have even more enlightened discussions.

    One of the perks of the medical profession is definately that you can essentially decide how many hours of work you want to put in per week precisely because of the fee-for-service system. Just like the on-commission salesperson who has sold enough vacuum cleaners or whatever in the morning and can therefore afford to go for coffee all afternoon in effect, any doctor can decide to provide only the highest paid services in the least amount of time and be unavailable for the rest of the time. Again, the fee-for-service system creates entrepreneurial doctors, whose perks have nothing to do with more women in the profession or a cultural difference between generations. The cost of living has increased obviously, so perhaps the problem of entrepreneurship is even more of a problem in the case of recent generations then it used to be, so the recent generations are working even less hours then their predecessors but working the system even more to their benefit.

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