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‘‘The negotiation of fees is entirely oneâ€" sided under the present system with the only leverage being the ability to express dissatisfaction by leaving the country or opting out."" said Dr. Thoburn. The family physician resides in Waterloo and has set up practice in Kitchener. He has opted out of the scheme twice and is presently back in. OHIP was born in the 1960‘s when provinâ€" cial governments began taking over health insurance from private insurance comâ€" panies: On April 1. 1972, the present system Page 8 â€" Waterico Chronicie, Wednesday, October 15, 1980 MD CLAIMS The battle between doctors and the preâ€" sent medicare system is being waged localâ€" ly. provincially. and nationally. Simply stated. according to Thorburn. doctors do not feel they are being adequately reimâ€" bursed for their services. At the peak of the controversy. it was esâ€" timated that up to one third of all Twin City doctors had expressed their dissatisfaction with the system by either opting out or leaving the country in search of greener pastures. Some doctors have since opted back in. ie Why is this figure significantly higher here than in other areas? According to Dr. W.M. Thoburn. president of the Kitchenerâ€" Waterloo Academy of Medicine, local docâ€" tors have always taken an active interest in medical politics and have a well organized Academy of Medicine. As a result he feels local doctors have a lot of independence. â€" By Terry James When it comes to medical care. Kitâ€" chenerâ€"Waterloo is unique on two counts. The Twin Cities represents the largest area not dominated by a university medical teaching facility. This ingependent atâ€" mosphere attracts a number of doctors who come to the area ready to roll up their sleeves and practice medicine. On a more negative note. Kitchenerâ€"Waterloo is also an area boasting a significantly higher number of doctors frustrated with the Onâ€" tario Health Insurance Plan «OHIP). Apâ€" proximately 25 per cent of all local doctors have opted out of the government scheme. Gome to us for the â€" money â€" Doctors‘ union may be necessary If you‘re in the market for a personal loan... The Royal Bank would like to say Featuring simple interest with no prepayment penalty, flexible terms and life insurance atho extra cost. Drop in at any Royal Bank branch today. &2 ROYAL BANK hi "CGan do!" (§19) 886â€"4 100 In 1978 the battle reached a climax. The Ontario Medical Association broke away and drew up a free schedule that was to be revised annually. The fee schedule was 30 per cent higher than OHIP was paying. The government refused to recognize it. The doctors had a choice. They could opt in the system or opt out. > f In order to compensate for low fees. docâ€" tors were sometimes forced to push their patients through their offices in an assemâ€" bly line fashion and work longer hours. In an open letter to patients, printed reâ€" cently in the Kitchenerâ€"Waterloo Record. Dr. Thoburn. writing on behalf of the local Acadéemy of Medicine. said doctors‘ fees became a matter of negotiation between the medical profession and the governâ€" ment."" When the demand for health care could not be controlled. expenditures had to *‘Despite responsible coâ€"operation and negotiation by the medical profession. docâ€" tors found their incomes falling behind the rising cost of living. Fees were no longer based on what medical services were worth, but what the government was wiHlâ€" ing to pay." wrote Dr. Thoburn. OHIP was meant to ease the confusion for people who had one premium for hospiâ€" tal and one for health insurance coverage. The new plan provided a wide scope of benefits for medi@cal and hospital services for every Ontario resident regardless of age. Doctors were given a choice. They could opt in and bill the government health plan or stay out and bill their patients directly. Because of the obvious convenienâ€" ce for both doctor and patient. 90 per.cent of all doctors made the decision to opt in. The plan paid 90 per cent of the doctor‘s bill and the medical profession was asked to acâ€" cept this as full payment for their services. came to life after the provincial governâ€" ment‘s two existing health plans, the Onâ€" tario Health Services Insurance Plan. and Plan were merged. gaea Dr. Thoburn claims that between 1971 When the report was made public this fall. the president of the local Academy said it made a great many points in their favor but the doctors‘ biggest concern was Justice Hall‘s suggestion that they not be allowed to charge patients more than the maximum fee set by the provincial health ‘Inflation for that year was running around the nine per cent range." said Dr. Thoburn. ‘‘*For me. opting out was an expression of dissatisfaction with the system at the time. It allowed me a means of compensating for inadequate renumeration through the OHIP system."" he said. He still remembers the day he decided to opt out. despite the realization it would mean more work and higher overhead. At an Ontario Medical Association meetingâ€" in Oct. 1978. the government had made an intiâ€" tial offer of a three per cent hike in OHIP fees. For three years. Anti Inflation Board controls had made it difficult for doctors to raise their rates above those which OHIP covered. It was at this point that some local doctors left the country. and 1979 there was a 40 per cent drop in docâ€" tors‘ disposable income. view of the health care system. Emmett Hall. a retired Supreme Court of Canada Judge. headed the inquiry. Twenty years previously he had initially proposed Canaâ€" da‘s publicly funded and administered health insurance system. _ One year later. OHIP‘s fee schedule was increased 11 per cent over a 15â€"month period. Upset by the number of doctors leaving the country. the Joe Clark government struck the Hall Commission in 1979. It‘s purpose was to conduct a nationâ€"wide reâ€" Dr. W.M. Thoburn, president of the Kitchenerâ€"Waterloo Academy of Mediâ€" cine, said doctors unions are inevitable if doctors are prohibited from chargâ€" ing patients more than the maximum fee set by the provincial health care plan and binding arbitration is used to settle fee disputes. _ L@(â€"£ Waterioo Alderman care plan. It also suggested that binding arâ€" bitration be used to settle fee disputes beâ€" tween physicians and provincial governâ€" ments. ‘‘There was some element of a threat in it but threat or no threat I see it as an inevitable development if legislation is brought in."" he said. No group in our soâ€" ciety has ever been forced into binding arâ€" bitration. On Oct. 2. the recently appointed presiâ€" dent of the Canadian Medical Association said he didn‘t believe doctors would ever strike. : "I don‘t think the federal government will go out of the way to antagonize the provinces."" he said. ‘"They won‘t push too Dr. Thoburn said that if Justice Hall‘s recommendations were legislated, the forâ€" mation of a union and "the withdrawl of service would be inevitable as it has in every situation in the world where doctors have been placed in this situation. _ ki s Ciodinalials Pore. aheo ces coliily " thes tvd se ap cabtr eArot : According to Dr. Thoburn the battle is far from over and ‘it‘s in their (the governâ€" ment‘s) ball park."" He said that if anything is going to aid the medical profession in its fight it is the timing of the constitutional reform debates. hard ‘*This has been rejected by local. provinâ€" cial and national medical associations." said Dr. Thoburn.â€" Following the report. Dr. Thoburn. speaking on behalf of the Kâ€"W Academy of Medicine. said that doctors would be forced to form a union. Was this an idle threat? "I think the man is speaking through his heart as opposed to his head."~ said Dr. Thoâ€" burn. I say this because I‘m not any more for a medical strike or medical union than anyone else is. I revere medicine as being a free and independent profession.