Arbitration and the Medical Profession

There has been much anguish, anxiety and animosity expressed regarding what is by far the most controversial recommendation of the recently-released report on the problems and prospects of Canada's health care systems by Justice Emmett Hall. Specifically, Hall (1980:28) recommends that 'when negotiations fail and an impasse occurs, the issues in dispute must be sent to binding arbitration, to an arbitration board consisting of three persons, with an independent chairperson to be named by the chiefjustice of the relevant province and one nominee from the profession and one from the government.' It is of crucial importance that there are two preconditions attached to this recommendation. The first is that provinces should exercise their power to 'outlaw extra-billing.' The second is that arbitration board decisions shall be final; that is, the legislation should contain a privative clause denying any right of appeal to both contending parties. This recommendation is clearly intended to resolve the key dilemma resulting from what Hall perceives to be the two dominant problems of the Canadian health care system. The growing practice by physicians to extra-bill was judged by Hall to threaten the survival of Medicare by inexorably leading to a two-class health care system. Based on a special study on the subject of extra-billing for the Hall Review, it was concluded that extra-billing '... must result inevitably in a denial of accessibility to some patients and a violation also of the principle of portability, both so essential to a nation-wide program' (Hall, 1980:32). Extra-billing also raises the issue of consumer risk-bearing relative to a system of universal, first-dollar insurance coverage and transfers health care costs from tax payers to the sick. These adverse effects have also been stressed in other recent studies, most notably by Barer, Evans and Stoddart (1979). They note that extra-billing is not likely to enhance cost control or to reduce utilization levels nor will it promote the technical efficiency with which medical services are produced. The other dominant issue is the conflict between the medical profession and the provincial governments over fee schedules. While the report provides scant supporting evidence that physicians' incomes are unreasonably low or that provincial government negotiators have been unjustifiably difficult or niggardly, one could surmise from Hall's sympathies that he suspects that both are at least partially true. It is evident from the report that Hall regards the increase in the phenomenon of extra-billing as mainly a reflection of physicians' dissatisfaction with recent fee-schedule settlements.1 The dilemma, often repeated in the report, is that physicians

Arbitration · Medical education · Medical profession · Political science · Canadian Policy and Governance · Healthcare Policy and Management · Law · Medical Malpractice and Liability Issues · Medicine · Psychology

• Supply projections as planning

  Open Access•Jonathan Lomas, Greg L Stoddart et al.•Social Science & Medicine•1985

  Add to list

• Extra-Billing and Physician Remuneration

  Herbert C Northcott•Canadian Public Policy•1982

  Add to list