Here's mo

Feb. 26, 2004. 01:00 AM

Liberals claim queue-jumping, extra billing exist
MPP discusses concerns at medicare hearing

Bill 8 would fine MDs for `two-tier' medicine


THERESA BOYLE
QUEEN'S PARK BUREAU

Some doctors in Ontario are illegally taking cash payments and
allowing patients to jump ahead in line to get faster treatment, according
to the Ontario government.

"I believe there is some queue-jumping happening," Liberal MPP Monique
Smith, parliamentary assistant to Health Minister George Smitherman, said
yesterday.

"I think there is some concern that there are people paying their way
to the front of the line and that's got to stop."

Queue-jumping and extra billing are violations of the Canada Health
Act.

Smith made her comments outside an all-party committee meeting where
MPPs were studying Bill 8, the Commitment to the Future of Medicare Act,
which would clamp down on such practices.

Smitherman also addressed the committee recently and raised similar
concerns.

"One recent example of queue-jumping is a clinic that allowed people
who were willing to purchase an enhanced lens for cataracts to get cataract
surgery immediately, while all other cataract patients had to wait a year
for the same surgery," he said last week.

"We cannot tolerate this kind of activity," he continued, calling it a
form of "two-tier" medicine.

The cataract case in question involved patients being charged between
$400 and $600 for a supposedly better lens. A government source cited one
example in which patients are told the lenses can help prevent conditions
such as macular degeneration. The Ontario Health Insurance Plan does not
cover the cost of such lenses because they are medically unproven.

The source cited another example in which patients are offered bifocal
lenses. Again, OHIP does not pick up the tab because such lenses are not
considered medically necessary. In both cases the operations are
reclassified as plastic surgery and patients get it faster, sometimes within
two weeks.

There are also cases of some doctors extra-billing patients by
charging them "block fees" for services that are already covered by OHIP,
according to government sources.

These fees - which usually range from $50 to $125 annually - are
intended to cover uninsured services such as renewing prescriptions over the
phone, writing sick notes to employers, providing telephone consultations
and filling out insurance forms. Not all doctors charge block fees, but
increasingly they are doing so to supplement their income.

Patients don't always know what they're being charged for and there
have been cases where they paid extra for services already covered by OHIP,
according to government sources.

Bill 8 would increase the transparency around block fees, ensuring
patients know what they are paying for. The legislation would also ensure
that patients know block fees are optional - and that if they don't pay
them, their access to a doctor should not be hindered.

OMA president Dr. Larry Erlick gave mixed messages to reporters when
asked about queue-jumping.

"I do queue-jumping every day. ... I just happened to have a cardiac
patient waiting for bypass and suddenly he's having chest pain at rest. So I
called up the surgeon and said you've got to move him up to the head of the
list because he's now a medical emergency. I don't apologize for that.
Doctors do that every day with their patients," he said.

"We're trying to play the system on how to get our patients access to
care because the waiting lists are too long."

Erlick later stressed the distinction between a medical emergency and
paying for faster treatment. "What I want to clarify is that I don't support
anybody paying for queue-jumping. I hope I didn't give you the wrong
message. ... Nobody should be able to buy their way to the front of the
line."

In its initial form, Bill 8 called for jail terms of up to one year
and fines of up to $50,000 for doctors caught allowing queue-jumping. The
province has since softened the penalties, removing any mention of jail
terms.

The amount of the fines is still being worked out.