June 27, 2004                                                                                                   BY FACSIMILE

                                                                                                                        (902) 752-1945

The Evening News

352 East River Road

P.O. Box 159

New Glasgow, N.S.

B2H 5E2

To The Editor:

I am writing about the health care co-operative proposed by Dr. Cathy Felderhof.  I attended the public meeting she held on June 15 which left me with more questions and concerns than before I arrived.  As someone who was involved in helping to achieve the Canada Health Act and a ban on extra-billing by Nova Scotian doctors in the early 1980’s, and who has also been involved in community health centres in Nova Scotia and Saskatchewan since the 1970’s, I am very concerned about Dr. Felderhof’s proposal.

In the first place, I am concerned that many of Dr. Felderhof’s patients are apparently already paying $8 a visit or $160 a year for her services.  Whether these charges are for insured or uninsured services, this represents a considerable cost to patients which I think is violation of the spirit if not the wording of the Canada Health Act and the Nova Scotia Health Services Insurance Act.  To my knowledge, these types of charges are not generally required elsewhere.  I have been a patient at the North End Community Health Centre in Halifax for almost 30 years and I have never had to pay to see a doctor, nurse, nurse practitioner, nutritionist or social worker.

I also think it is important to remember that when extra-billing by doctors was banned in 1984, it was with the clear understanding that doctors would stop charging patients directly and instead negotiate with the government for what they feel they need in terms of remuneration and coverage of their costs. In fact, the legislation (Bill 106) that was passed provided a final offer arbitration process to help resolve all outstanding issues in negotiations between the Medical Society and the government.

At the meeting, Dr. Felderhof suggested that a move to a co-op for her practice was a move away from privatization. I suggest the opposite is actually the case because the co-op would provide an organizational structure to entrench these fees so that they are no longer at the discretion of a physician directly with her/his patient but actually established by the co-op in consultation with the doctor.  In other words, what has been established by a doctor on her/his own now becomes part of an organization acting on behalf of the doctor, that is, a private clinic.

In addition, I have major concerns for patients who cannot afford to pay such fees.  It was not clear at the meeting what would happen to them.  But based on our earlier experience with extra-billing and user fees in general,  what generally happens is that these patients on low or fixed income are generally prevented from using services when they need them.  Such fees can also be an unnecessary administrative cost.  

One of the main reasons that Medicare was established was to eliminate financial barriers to receiving needed health services at the time of service.  For the thousands of Nova Scotians who worked to get rid of extra-billing twenty years ago, we certainly did not want to see one set of patient charges for insured services replaced by a new and increasing set of fees for so-called uninsured services.

I am also concerned that Dr. Felderhof suggested she will be making a decision on whether or not to continue with her practice based on how patients respond to this proposal by July 1 and again a year later. This puts patients in a very difficult position of having to accept this proposal or face the prospect of losing their family doctor.  Putting potential members in such a position seems contrary to accepted co-operative principles.  Will the members really be in control or Dr. Felderhof?

At the meeting, the Nova Scotia Co-operative Council suggested this co-op proposal would be the first of its kind in the province.  However, this is not the case.  In 1988, the Nova Scotia Federation of Community Health Centres and the Co-op Council presented a formal proposal for developing co-operative health centres to the Royal Commission on Health Services.  While a cooperative health centre may not yet have been established, community health centres have been developed in at least 8 locations across the province.  One of the key principles of a community health centre as identified by the Federation in 1992 is that of improving accessibility to health services for the community it serves.  Obviously, this should also be a key principle of any co-operative health centre.

I am also not aware of a co-op centre elsewhere that is organized to charge patients for uninsured services of doctors.  For example, community health centres in Saskatchewan were established in response to a threatened doctors’ strike when Medicare was being established in 1962..   These centres later also actively opposed patient user fees called “deterrent fees”.  However, this co-op seems to be organized around the payment of such user charges.

I therefore urge patients of Dr. Felderhof not to accept the idea of having to pay for uninsured services in the new co-operative if it goes ahead and instead to have it funded under a global budget with the Department of Health and the District Health Authority.  This is already the case for at least two community health centres in Nova Scotia and there is no reason why this couldn’t happen in Pictou County as well.

Ian Johnson

Vice-Chairperson

Nova Scotia Citizens Health Care Network

P.S.  I can be reached at 1-877-556-4738 or (902) 424-4063 (work) or (902) 454-2549 (home).

 Put the Heart Back in Medicare - Keep Profits Out!