Author: Ezra Yu
The government only pays doctors who paid fee-for-service (FFS) and who bill the government for a medically necessary physician or hospital service for that services. Therefore, patients are not involved in paying for that Fee-for-service. In general, FFS encourages doctors to move patients through quickly, which can decrease the quality of care, especially for sicker patients. For a better quality health care, some patients are willing to pay an out-of-pocket for FFS. So saying that patients decide to pay out-of-pocket for a service offered by an FFS doctor for better quality service, they choose the fully private clinics. The fully private clinics which provide private delivery and private payment (i.e., payment from patients, not government) are not allowed to bill the public plan unless they would take 100% of the payment from the government (i.e., not extra bill patients on top of the government payment) because extra billing is against the law under the universal public insurance plans in each province. However, this situation is confusing who is paying the doctor that FFS because that the public insurance covers the medically necessary physician or hospital service for the services is also ascribed to the Canada Health Act. Likewise, I believe what the most fully private clinics want is to take the government payment and bill the patients on top of that. The same thing also applies to doctors who are paid under capitation by the government, because there is no patient payment involved in capitation either. The capitation is the agreement that the government pays a set of an amount by enrolled patients assigned to them per period. The capitation does not just allow doctors to build better relationships with patients; capitation also frees doctors up to concentrate on the sicker patients because they get paid for all patients each month even if the patient doesn’t come in, it allows doctors to make money as crazy from the enrolled patients assigned to them.
By the way, I refer the doctors to GPs only…
In Canada Health Act(CHA) design, the system is predominantly public financed and privately delivered. The Canada Health Act combined and replaced the Hospital and Diagnostic Services Act and the Medical Services Act in 1984. The event in Saskatchewan (SK) such as the famous 23 day’s strike just prior to creating public insurance for physicians (which then was followed by the federal Medical Services Act). It mainly results from that physicians didn’t want to be working with the government, so they went on strike to remain autonomous. SK government thought it would be much easier to only have public payment and allow physicians to still function as private forms of delivery. By the time the Canada Health Act replaced the other two Acts, physicians were even more powerful and even less likely to want to change their status. The government wanted physicians’ willingness to accept Fee-for-service(FFS) remuneration method. The CHA allows physicians to choose their own medical practice locations and facilitators in exchange for the FFS remuneration method. Intuitively, the Canada Health Act is the inception of the current Medicare approach. The current Medicare approach in Canada leads physicians to have a chance to create the long waiting time.
Read more about the history of the Canadian health system: