To the Editor:

I am writing in response to John Gillis' Dec. 28/05 article entitled "MD offers monthly fee service".  I
found this article to be very disturbing.

In the first place, one of the major reasons Medicare was established in Nova Scotia and across the country
almost 40 years ago was to eliminate financial barriers for any needed health service.   The practice of doctors charging for so-called uninsured services whether at the time of service or on a monthly or yearly basis goes against this basic principle.

I think it is important to remember that Nova Scotia was the first province to ban extra-billing or balance
billing by doctors in 1984 after the Canada Health Act was passed that same year.   And the clear intent of
this ban was to stop direct charges to patients for insured or uninsured services.   In fact, when some doctors in Halifax charged for prescription refills right after the ban took effect, the then President of the Medical Society wrote to all doctors in the province advising them against such charges.

Regrettably, both the Department of Health and the Medical Society/Doctors Nova Scotia have allowed these
charges for uninsured services to continue and even be  expanded.  The intent of the legislative changes in
1984 was to make sure doctors would negotiate with the government for what they feel they need in terms of
payment and coverage of their costs.  In addition, the legislative provided for a final offer arbitration
process to help resolve all outstanding issues in these negotiations.

I therefore question why patients should have to pay for such services as paper file management, ear
syringing, prescription refills or telephone access. For many patients, these services may be as important
as seeing their doctor in their office.  Why would they continue to be treated as "uninsured services"?
As a longtime patient of the North End Community Health Centre in Halifax, I have never had to pay for
any of these services and I don't think anyone else should either.

Despite the assurances of Doctors Nova Scotia that no one should be denied a service if they can't pay, the
research on user fees clearly shows this happens especially for persons of low and fixed incomes.  This
is especially the case if you or your family has been going to the same doctor for years. In fact, the Nova
Scotia Citizens Health Care Network has heard from patients of Dr. Kazimirski when he first introduced
this payment plan in his practice and we forwarded their concerns to the Department of Health from whom
there has been no response.

It is long overdue that both the Department and Doctors Nova Scotia acted to stop patients from being
billed for these uninsured services.  The extent of billing for uninsured services should be investigated
and publicly reported as extra-billing for insured services was prior to 1984.  Most if not all of the
current uninsured services should be recognized as insured services.  And any doctors charging for
uninsured services should not also be able to receive payment from M.S.I.

Literally thousands of Nova Scotians supported the end of extra-billing by doctors in the mid-1980's.  We
didn't do so just to see one form of direct charges by doctors replaced by another.

Ian Johnson
Vice-Chairperson
Nova Scotia Citizens Health Care Network
3591 Claremont Street
Halifax, N.S.
B3L 3L9
454-2549 (home), 424-4063 (work)