Health News Briefs
January 1992 to December 1994

Compiled by Ulli Diemer

This document contains brief summaries of news items relating to health and health policy in Canada during the period January 1992 to December 1994. All items appeared in Medical Reform, the newsletter of the Medical Reform Group of Ontario, and are in the order they appeared, starting January 1992.

Abortion clinic attacked
The Morgentaler abortion clinic in Toronto was subjected to an arson attack on January 24, 1992. A flammable substance was used to ignite the front doors. The fire caused $5,000 damage to the clinic and $2,000 damage to an adjacent building. Three people were forced to flee their apartment above a neighbouring store.

Genital mutilation banned
The College of Physicians and Surgeons has issued a statement telling doctors not to perform so-called `female circumcision'. The move came after some doctors reported being approached by immigrants from Africa to perform the ritual on their daughters. The College also called on the federal government to outlaw the practice, which is a traditional practice is some parts of Africa. Various forms of the practice can involve removal of the clitoris and the labia, and sewing shut of the vagina.

Anonymous AIDS testing
The Ontario Ministry of Health has selected eight municipalities to set up anonymous AIDS testing facilities.

AIDS registry to be set up
The task of setting up the federal government's AIDS information registry has been turned over to a private company, Price Waterhouse. The registry was to have been set up under the auspices of the University of Toronto, but after a series of problems and controversies, the government took the project away from the university. The registry is to feature a computerized data base containing the latest information on AIDS treatments. The data are to be available to doctors and patients across Canada, and is now scheduled to be in operation sometime this spring.

Racism charged
The Congress of Black Women of Canada has called for an inquiry into racism in Ontario's health care system. "This is a huge problem in health care facilities", said Akura Benjamin of the Toronto chapter of the Congress. The Ontario Human Rights Commission is currently conducting an inquiry into allegations of racism in promotion practices made by nine nurses at Northwestern Hospital in Toronto.

Secrecy deals under fire
Lawyers representing plaintiffs in suits against breast- implant manufacturers say they had documents at least eight years ago which showed that the manufacturers knew that the implants could be dangerous. However, because of court- approved secrecy agreements, known as protective orders, they were prevented from making the information public. Manufacturers in the United States routinely demand secrecy agreements as a condition of settling lawsuits. As a result of the secrecy agreements, officials of the U.S. Food and Drug Administration did not learn about studies which showed the implants might be dangerous.

New Zealand protests
A series of marches and demonstrations took place in New Zealand last month to protest against the implementation of user fees and health care cutbacks. With the new measures, New Zealanders will be charged for hospital treatment for the first time in 50 years. Those on unemployment or social welfare benefits will have to present a special card to qualify for free hospital care and reduced charges for visits to primary care physicians. Low-income people who do not qualify for free hospital care will receive a partial subsidy. Those classified as "high-income" have to pay full rates. The "high-income" category includes almost half the population.

Tsongas rebutted
Democratic presidential candidate Paul Tsongas' swipes at the Canadian health care system have attracted spirited rebuttals from north of the border. Tsongas, a bone marrow transplant recipient, stated that if he had sought treatment in Canada, he might have died, because "socialized medicine" stifles life-saving research and technology. Doctors at the Ontario Cancer Institute/Princess Margaret Hospital have pointed out that the research which made Tsongas' transplant possible was in fact done in Canada, at the OCI/PMH, by Drs. Ernest McCulloch and James Till. Dr. Don Carlow, president of OCI/PMH, was quoted in Ontario Medicine as saying that Tsongas "was fortunate to be in a position to afford the best treatment available in the U.S. Many Americans do not have the same privilege."

What the doctor ordered
How does the thrusting hospital maximise its income in the market-style National Health Service? Simple: it gets patients to give far-off addresses, sends them to the wrong wards and discharges them before they are fit. These and other tricks of the trade are disclosed in the latest issue of The Health Service Journal by an anonymous health authority director of purchasing, whose job is to scrutinize and settle hospitals' bills. First, and most important, is to try to stop the patient giving a local address. Students, temporary workers, members of the armed forces and other should be inveigled into giving their "permanent" address, likely to be in another health district which has not contract with the hospital and can therefore be billed for extra cash. A patient taken to the wrong department and left, even if only for a few minutes, can enable the wily hospital to send two bills. Some provider units have submitted such claims for admissions lasting less than a minute. If possible, the director suggests, try to discharge the patient before treatment is ended: most patients will readily co-operation with a readmission shortly afterwards. "You can then charge for two admissions at average specialty costs which were, of course, based on the length of a normal admission. This will double the value of the patient at a fraction of the cost."
David Brindle, in the Manchester Guardian Weekly, February 9, 1992

Therapist sues patient
A Toronto therapist has successfully sued a patient for a cancelled appointment. Dr. Stephen Sibalis, (9 Sultan Street, Toronto, (416) 923-8666 (W), (416) 461-9655 (H)) a member of the Committee of Concerned Physicians, won in court because he had required his patient to sign a contract in which she agreed to pay for appointments whether she used them or not. The contract also stipulated that she would pay for additional services not covered by OHIP, and that she would be charged compound interest on any missed bill. The contract stipulated that she would have to pay for a cancelled appointment no matter how much in advance it was cancelled, and no matter what the reason for the cancellation was. Asked to comment, Mimi Divinsky of the Medical Reform Group of Ontario said that contacts put patients at a disadvantage because of the obvious power imbalance. "It isn't a contract between equals"', she said.

New doctors hit
The Ontario government has moved to prevent new physicians from entering practice in the province's urban centres. Physicians who set up a practice in an area which is considered to have an over-supply of doctors will only be paid 25 per cent of the normal fee schedule. Since overhead costs are nearly always greater than 25 per cent of billings, this will effectively prevent any new physician from setting up practice in an urban area. The government says the move is designed to increase the number of physicians in under-serviced rural and remote areas of the province, while curbing the over-supply of doctors in cities. However, the way the government is moving to achieve these goals have been strongly criticized as unfair and arbitrary.

Enrollment cut at medical schools
Enrollments at the University of Toronto's medical school are being cut by 30 per cent. Only 177 new students will be enrolled this fall, rather than the usual 252. The cuts are part of a national effort agreed on by provincial ministers of health. Other cuts are taking place in medical schools in Alberta and Manitoba. Enrollments in other provinces, and in Ontario's four other medical schools, are being frozen. According to Michael Decter, Ontario's deputy minister of health, there are too many doctors in Ontario and in Canada. "Studies have shown that each new doctor that goes into practice costs us an average of $500,000 a year, when you consider what they bill, all the lab tests they order and hospital services that result." A ministry statement said that the number of physicians rose by 38 per cent from 1981 to 1991, while the population rose 12 per cent. Over the same period of time, health insurance payments to physicians in Canada went up 128 per cent.

Billing limit eased for some
Some doctors in rural and remote parts of Ontario will get a partial break from the provincial government's billing restrictions. The government previously imposed a "cap" on physician billings at $400,000 per year. Billings above that amount are paid at two-thirds of the regular rate, and at only one-third of the rate for billings above $450,000. But under a new deal between the government and the OMA, specialists in under-serviced areas can apply for an exemption from that limit. The Ministry of Health estimates that between 30 and 50 physicians will qualify for the exemptions. Currently, doctors who move to such areas are exempt from the billing limit for four years while they set up their practices. The new deal would give specialists an additional two year exemption. Speaking for the Medical Reform Group, Dr. Mimi Divinsky said that the exemption is only a bandaid solution to the problem of overburdened doctors. She said the exemption will not solve the problem of overworked doctors and will reward those who practice "revolving-door medicine". "Doctors who consistently bill higher than the limit are overworked and not able to spend the time needed with each patient", she said.

Cutbacks in Emergency
In an effort to cope with funding restrictions, some hospital emergency rooms will start sending certain types of patients back home instead of admitting them, the Ontario Hospital Association has announced. According to Beth Witney of the OHA, the measures will affect only those who don't really need to be admitted to hospital, such as elderly people with arthritis or problems with their medication. The measures are to be coupled with the use of quick response teams, usually headed by a nurse, which are supposed to follow up to make sure that patients' needs are taken care of and that they are able to cope at home on their own.

Birthing centres
The Ministry of Health has asked for proposals to set up three out-of-hospital birthing centres to be staffed by midwives. Licenses for the centres are expected to be issued by the beginning of 1994, and the centres are expected to be operational by the fall of 1994. Midwives in the centres are to be salaried. Midwives are expected to be fully licensed and funded in Ontario by the end of 1993, and three Ontario universities will be offering midwifery programs.

Province announces cuts
Ontario's NDP government has announced that it intends to implement a series of austerity measures to reduce government costs, including the costs of health care. $1 billion is to be cut from the health care budget, $313 million from the social services budget, and $635 from the education budget. Among the measures being brought forward are plans to require seniors and the poor to pay more for drugs, and to restrict medical services to refugee claimants. A proposed reorganization of the Ontario Drug Benefit Plan will require the 2.4 million Ontarions who now receive free pharmaceuticals to pay a fee. A total of $195 million is to be cut from the OFBP. The parents of more than 13,000 children in residential care will be required to pay some portion of the cost of their accommodation. The Oxford Regional Centre, which cares for 244 developmentally disabled residents will be closed. Payments for all non-emergency procedures done outside the province will be ended, unless they have been approved in advance. The government has said that it plans to chop $275 million from the $4 billion annual payment to physicians, but details are to be negotiated with the Ontario Medical Association. A cut of that size would translate into an average reduction of $11,000 per year for the province's 25,000 licensed physicians, if the reductions were spread out equally. Hospital budgets are to be cut by $160 million.

B.C. doctors want union
The British Columbia Medical Association announced on April 6 that it is seeking recognition as a union. Dr. Derryck Smith, a member of the association's executive hoard, said unionizing doctors has become possible through revisions to the province's labour relations code covering "dependent contractors". Physicians would continue to function as self- employed professionals, he said. The move comes after a year of tough bargaining between the BCMA and the government, marked by walkouts, large-scale advertising campaigns, and acrimony.

Hospitals woo U.S. patients
The Toronto Hospital and the Hospital for Sick Children have teamed up to market medical services and surgical procedures to insurance companies and employer plans in the United States. "Free trade means free trade," said Dr. Alan Hudson, president of the Toronto Hospital. The hospitals maintain the plan will not displace Ontario patients or lengthen waiting lists.

Private MRI clinics
Alberta doctors and businessmen are setting up two private magnetic resonance imaging clinics which will charge patients $1,000 per visit. MRI clinics in the U.S. are among the most profitable businesses in the health care industry but these are the first private MRI clinics in Canada. Patients who can afford the fee can bypass the queue for the province's two hospital-based, medicare-funded MRIs. The waiting list can be several months for patients not considered to be emergency cases. "If we don't do this, somebody else will," said Dr. Chen Fong, director of the newly-opened Western Canada MRI Centre of Calgary. According the Dr. Fong, U.S. companies are already exploring the possibility of setting up privately owned MRI clinics in British Columbia and Ontario. According to Dr. Michael Rachlis, a health care consultant and member of the Medical Reform Group, the Alberta government's decision to allow the private MRI clinics appears to violate the Canada Health Act. "Its a stake through the heart of medicare, allowing hospitals to make referrals to private clinics when the only people able to go are the wealthy who can afford it," he said. The province has already apparently decided that doctors who bill patients directly for an MRI scan will not be required to opt out of the provincial medicare plan, as all other physicians who direct bill have to do. Dr. Rachlis also criticized letting doctors refer patients to MRI clinics in which they have a financial interest. "These kinds of self-referrals are already banned in several states in the U.S.", he said.

Canadian drug prices high
According to a study prepared by the Patented Medicine Prices Review Board, a federal agency, the prices of brand- name pharmaceuticals are consistently higher in Canada than in other industrial countries, and are often the highest in the world. The study of 177 top-selling prescriptions drugs found that Canada had the highest prices for 42 of them, the second-highest for 35, and was above the median for a total of 105. Another study prepared by the PMPRB shows that the price increases of brand-name drugs were significantly higher than the rate of inflation during the first six months of 1992. The studies were not released to the public, but copies were obtained by the Globe and Mail newspaper.

Quebec pays for organ retrieval
The number of organs collected for transplant patients has increased in Quebec after the government starting offering hospitals financial incentives. Quebec-Transplant, the non- profit organization that co-ordinates organ donations, began offering $500 to each hospital that refers a donor and $4,500 to the hospital that retrieves the organ, at the beginning of the year. During the first three months of the program, it collected 87 organs, up from 57 during the same period the previous year.

Saskatchewan hospitals overused
A provincial health care commission has concluded that Saskatchewan's hospitals are being used to provide care that would more appropriately be provided in another setting. The commission found that in some hospitals, only 36 per cent of acute-care beds were filled by seriously ill patients. "That doesn't mean that the patients did not require care -- it means that the care could have been provided at alternative institutions," said Dr. Stewart McMillan, head of the commission. Dr. McMillan said that there seems to be a problem in providing appropriate care for older people, especially in rural communities. "Older patients get admitted... then they get better and they appear not to be able to move back into the community or nursing homes or whatever", he said.

OMA plan flawed, College says
The College of Physicians and Surgeons of Ontario is opposing a proposal from the Ontario Medical Association that would restrict the College's power to grant exemptions from licensing requirements to foreign specialists. At present, the College grants a limited number of exemptions (34 in 1991) to foreign specialists in specialties where there is a shortage, allowing them to begin practise immediately. The OMA's board of directors is proposing the power to grant exemptions be turned over to the government. According to OMA President Dr. Michael Thorburn, "there's tens of thousands of unemployed physicians" around the world, and Canada has to reduce numbers coming here at a time when medical schools here are having to cut enrolments. According to CPSO Registrar Dr. Michael Dixon, decision- making power over licensing requirements must remain exclusively with the College.

Computers to track prescriptions
The Ontario Ministry of Health has announced a computer network which will track patients' prescriptions. The stated purpose of the system is to prevent over-medication and drug interactions by giving pharmacists information on what drugs their customers are taking. The Ontario Drug System will connect about 2,500 pharmacists' computers to the health ministry. Green Shield Canada has been awarded the contract to set up and oversee the network in partnership with the Ministry of Health. Pharmacists are supposed to contact a patient's physician if the network identifies a problem. The Ministry of Health suggests that the network could be expanded to include other health care providers, including hospitals, private health insurers, and individual physicians. The plan drew support from Seniors'' groups, but was criticized by John Raufoy, a registered nurse who ran as an NDP candidate in the last provincial election. "This is an amazing invasion of privacy," he said. Raufoy said the computers will give too many pharmacists and doctors access to sensitive medical information. "The only reason for this is to save money, not lives," he said. "I can't believe my party is doing this. It's just one more example of Big Brother."
14 May 1993

Two-tier system advocated
The Fraser Institute, a right-wing think-tank with close ties to the Progressive Conservative government, is advocating that wealthy Canadians should be able to queue- jump if they pay the full cost of their medical treatment. According to Michael Walker, the executive director of the Fraser Institute, such an approach would help everyone because it would put more money into the system.
20 May 1993

Abortion bans don't work
Abortions are more common in countries that ban or restrict the procedure than in those where it is widely permitted, according to a report published by the International Planned Parenthood Federation. "It is a popular myth that abortion figures are highest in countries where abortion is most easily available," said Frances Perrow, a federation spokeswoman. According to the report, countries in Latin America which ban or restrict abortions have abortion rates of 30 to 60 for every 1,000 women, while in western Europe, the rate is about 14 abortions for every 1,000 women. The report suggested that countries with tough abortion laws also have few sex-education programs and generally limit the availability of contraceptives -- increasing the number of unwanted pregnancies.
29 May, 1993

Setback for blood plant
A proposal by the Canadian Red Cross to build a blood fractionation plant in Canada received a setback after the Canadian Blood Agency rejected it. Currently Canadian plasma, collected from volunteer donors, is shipped to U.S. plants for fractionation. The Red Cross said that the $100- million Canadian plant would save taxpayers $400 million over a ten-year period and ensure self-sufficiency and safety of blood products. The Red Cross manages to collect only about 75 per cent of the plasma required to meet the needs of Canadian hospitals. The rest is bought in the United States and Europe. Canada's tainted-blood scandal, which saw more than 1,000 hemophiliacs and blood-transfusion patients infected with the AIDS virus, resulted in part because products made with contaminated blood from the United States were imported into Canada to meet shortages.
2 June 1993

New Thalidomide victims
Thalidomide, the sedative which was banned worldwide in 1962 after thousands of infants whose mothers had taken it were born without arms and legs, is producing a new group of deformed infants in Brazil. After being banned, Thalidomide was re-introduced in Brazil in 1966 as a treatment for leprosy only. Brazil's health ministry says that use of thalidomide is strictly monitored, but investigators have presented evidence that hundreds of deformed infants have been born and that medical officials have deliberately destroyed evidence to cover up many of the cases. Investigators found that drugstores were selling thalidomide without a prescription, and that many illiterate women taking it were unaware of the risks..
2 June 1993

Depo-Provera
The manufacturer of Depo Provera is appealing the federal health department's decision not to allow the drug to be marketed as a long-term contraceptive in Canada. Depo Provera, which is licensed as a cancer treatment in Canada, was given final approval as a contraceptive by the World Health Organization in June. Opponents of Depo Provera have repeatedly raised concerns about its long-term effects on women.
3 June 1993

HIV+ blood donors liable
The Supreme Court of Canada has ruled that people who knowingly donate HIV-infected blood can be prosecuted under existing laws. The court upheld the 1989 conviction of an Ottawa man who donated his blood to the Red Cross even though he knew he had tested positive for HIV and had been told not to donate blood. He began serving a 15-month jail sentence after the Supreme Court ruling.
5 June 1993

Hospitals advocate competition
The Canadian Hospital Association is calling for dramatic changes to the delivery of health care, including the introduction of market-style competition for hospital patients and the elimination of public financing for non- essential services. The association's Vision Project Report, released in June at the annual convention of the CHA, proposes that hospitals be forced to compete against each other for patients and public money. "We're talking about emulating the market system" said CHA president Carol Clemenhagen. "If some institutions are not as efficient as other institutions, they shouldn't be receiving public funds for that facility." The proposal is modelled in large part on reforms introduced in the British National Health Service by Margaret Thatcher's Conservative government several years ago. The CHA report calls for a fixed level of health care funding based on providing a core list of services. Services not on the core list would no longer be available unless patients paid privately, along the lines of the system adopted in the U.S. state of Oregon.
10 June 1993

Smoker denied surgery
Physicians in the United Kingdom triggered a public debate about medical ethics after the death of a patient who had been denied non-urgent heart bypass surgery because he was a smoker. Dr. Christopher Ward, a Manchester cardiologist, said that "we're not penalizing smokers and not discriminating. The fact of the matter is the benefits they might get from having coronary bypass surgery are negated by the fact they continue to smoke." According to Dr. Ward, the evidence shows that non-smokers have a significantly greater chance of benefiting from bypass surgery. Others disagreed with the policy,. "My view is that once we accept an absolute bar to surgery for smokers, we... may well be on the slippery slope to withholding treatment for the unmotivated and unfit," wrote Dr. Matthew Shiu in the British Medical Journal. A smokers' rights group said that many others, including people infected with AIDS by drug use or sexual activity, alcoholics with liver disease, and athletes with sports injuries, are not denied treatment for conditions resulting from lifestyle choices. Dr. John Bailey, who opposes non-urgent surgery for smokers, said that likely clinical outcomes will have to be weighed more carefully as waiting lists for coronary surgery grow longer.
11 June 1993

Minister quits over "social contract"
Karen Haslam, Minister Without Portfolio for Health in the Ontario NDP government, resigned from the cabinet on June 14 in protest against the "social contract" legislation. "I firmly believe in the rights of free collective bargaining," Haslam said. "Any time you legislate an override on a collective agreement, I can't support that and I will vote against it," she said.
14 June 1993

Corporations want tax cuts
A group of 15 major corporations is proposing that companies should receive a rebate on their employer health tax if they offer health and fitness programs to their employees. The idea received endorsement from Ontario's deputy minister of health Michael Decter, who said "there is huge yardage to be gained, both for employers and for the society as a whole, in finding ways to contribute to employee health".
15 June 1993

Community care changes and fears
Patients' advocates are expressing concern that the Ontario government is rushing into a plan to shift psychiatric patients out of institutions before the services needed for community-based care are in place. The government announced in June that the number of psychiatric beds in Ontario are to be cut in half over the next 10 years. "We have to transform services that are fragmented so that we have a co- ordinated system," Health Minister Ruth Grier said. "Many of the people who have been occupying psychiatric beds for many years have not been getting treated and in fact can be more effectively treated in other ways." "I applaud this but I'm scared," said June Beeby of the Ontario Friends of Schizophrenics. "You've got to have transitional money, and there isn't any. You've got to have the support services up and running. This will mean a gap of a few years, and they have already taken $45 million out of the mental-health envelope." She cited lengthy waiting lists for community-based therapy. "It sounds great in theory and God knows I'd like it to work, but I think it will be a disaster," she said. "If there are fewer beds for the very ill and no more money for mental health services over-all, it doesn't take a rocket scientist to figure out that this will mean more people living on the streets." There are 370 community mental health programs in the province, providing case management, social rehabilitation, housing, vocational aid, psychogeriatric care, crisis intervention, day treatment and counselling. But studies show that there is a wide variation in services. "You can have 370 programs, but the vast majority of them wouldn't let a schizophrenic in the door," Ms Beeby said. Ms Grier said in her announcement that she will not eliminate beds until community care is established, but Martha Gandier, co-ordinator of Toronto Psychiatric Survivors, a self-help group, is skeptical. She says that when the previous Progressive Conservative and Liberal governments closed institutions in the 1970s and 1980s, they made the same promises, but patients found themselves on the streets, isolated, without human contact, living in rooming houses in an endless cycle of poverty.
17 June 1993

Hospitals to close
Some Metro Toronto hospitals will have to close and others merge as the government tries to reform health care, Health Minister Ruth Grier has said. Grier says that she wants a plan for the closings by the end of the year.
17 June 1993

Non-profit homemakers planned
Health Minister Ruth Grier has announced that the province wants to replace private agencies supplying homemakers for the aged and handicapped under Ontario-funded programs with non-profit operations. "In these times of restraint, the government prefers to see tax dollars directed toward services for consumers, and workers' wages, rather than profit," Ms Grier said. The Ontario government estimates its funding supports about 15,000 homemakers, who provide the elderly and handicapped with help in shopping and household chores. The service makes it possible for people to remain in their homes rather than be placed in institutions. The province spends about $190 million annually on homemaker services. Private agencies provide nearly half of the publicly funded home care in the province.
26 June 1993

Tories eye user fees
The federal Progressive Conservative government is leaving the door open to the introduction of user fees for health care. Both Kim Campbell and Jean Charest suggested that user fees should be looked at as an option during their runs for the leadership of the party. Campbell later said that she personally didn't think user fees for "medically necessary" treatments were the best way to go, but didn't say she would lift a finger to stop provinces from introducing them. She also said that charging patients who go to a hospital for what is deemed to be a non-emergency condition that could have been handled by a clinic would not be a "user fee", since the hospital visit would not be considered a "medically necessary" service. This would not be a "user fee" said Campbell, "it's to discourage people from getting their services in an expensive place as opposed to a more cost-effective place." In Tory code, "Never" and "Sacred Promise" mean "Not until after the election", while "Maybe" and "Wouldn't rule out" mean "Not until after the election".
26 June, 27 August 1993

Rural MDs form group
A group of rural MDs has formed the Society of Rural Physicians. Dr. David Fletcher was elected the first president of the organization, which is based in Mount Forest, Ontario. Among the issues to be addressed by the group are a shortage of physicians in rural communities and the closing of small-town hospitals.
3 July 1993

Refugees to lose coverage
Ontario's NDP government is moving to remove OHIP coverage from refugee claimants, temporary workers, and foreign students. As many as 167,000 people could be affected, according to figures compiled by the Ontario Ministry of Health. At present, temporary Ontario residents are covered by OHIP in the same way that permanent residents are. Under the new legislation, they would lose that coverage and have to pay their own medical bills. Health Minister Ruth Grier said that it is the government's intention to restrict coverage to those who are considered permanent residents. The government has been pressing the federal government to pay for the health care of refugees.
3 July 1993

Drug money
The brand-name drug companies who benefited from the Progressive Conservative government's drug patent legislation made substantial contributions to the Progressive Conservative Party. Figures released by Elections Canada show that in 1992, the PC Party received contributions from the Pharmaceutical Manufacturers Association of Canada and from many of the individual multi- national drug companies. However, in keeping with the corporate custom of hedging bets by supporting both of the main pro-business parties, many of the drug manufacturers also made smaller contributions to the Liberal Party
21 July 1993

Pay equity deal
The Ontario Hospital Association has agreed to give about 40,000 nurses a one-time payment of $4,100 in a pay equity deal. The payment will raise the maximum annual salary of full-time nurses from $52,000 to $54,210 by January 1996. The hospital association represents 171 hospitals. Another 53 hospitals in Ontario are not covered by the deal. Hospital association president Dennis Timbrell said the agreement will cost hospitals about $123 million in retroactive pay and an additional $66 million in annual costs by 1996. Pay equity adjustments, which compensate for past pay inequities, are not affected by the province's "social contract" legislation.
22 July 1993

AZT court case
A U.S. federal judge has ruled that the U.S. pharmaceutical company Burroughs-Wellcome is the sole inventor of the anti- AIDS drug AZT. Burroughs-Wellcome sued Novopharm Ltd. of Toronto, Barr Laboratories of Pomona, New York, and the U.S. National Institute of Health, after the two companies applied for permission to produce a generic version of AZT. Novopharm and Barr argued that the AZT patent was invalid because the drug was developed by public money, and that two scientists at the U.S. National Institute of Health were co- inventors of the drug. In a case which observers characterized as "bizarre", Judge Malcolm Howard allowed Burroughs-Wellcome to present its case and then ended the case and handed down his ruling without allowing the other side to present its case. Novopharm and Barr are asking that a mistrial be declared, but in the meantime are prevented from marketing the drug.
23 July 1993

Charities lose under "social contract"
Ontario charities in the health care field are having to turn money over to the province under the NDP government's "social contract" law. The charities are being made to turn over 5 per cent of their payroll costs for the next three years. Charities fall under the "social contract" if they receive any of their funding from the provincial government. The clawback applies even if agencies' payrolls exceed the total amount they receive from the government in the first place.
28 July 1993

Restrictions on out-of-province MDs
The Ontario government has put a moratorium on the right of new doctors coming into the province to bill OHIP. Effective immediately, doctors entering Ontario with degrees from medical schools outside the province will be able to practice medicine only if they go on salary or accept some other form of alternative payment. They will not be allowed to bill OHIP under the fee-for-service system. The moratorium is to last until March 31, 1996, when the government's "social contract" program expires. However, the moratorium may be challenged under Canada's Charter or Rights and Freedoms. Constitutional lawyers said that the government's new rules appear to violate Section 6 of the Charter, which states every citizen has the right to pursue a livelihood in any province.
6 August 1993

Private sector bureaucracy
A new study has found that 24.8 per cent of all U.S. hospital costs go for administrative expenses, about twice the proportion spent in Canada. The study, based on federally-mandated cost reports from each of the nation's 6,400 hospitals in 1990 and published in the New England Journal of Medicine in August, estimates the U.S. could save $50 billion a year on hospital administration costs by shifting to a Canadian-style health system. A second study, by Steffie Woolhandler of Harvard Medical School and Sidney Wolfe of Public Citizen's Health Research Group, estimated that under a single-payer system, the U.S.'s total health system (not just hospitals) could save about $117 billion a year on administrative costs, including the $50 billion on hospitals.
15 August 1993

BC NDP limits payments
British Columbia's NDP government has introduced new guidelines as part of an agreement with the province's doctors under which the provincial health care plan will no longer pay for services that are not considered medically necessary. If a patient wants a service which is not considered medically necessary, he or she will have to pay for it. Prime examples of such services would be tests for which there is no medical indication. The guidelines to be applied are to be developed by the province's new Medical Services Commission, a tripartite body including government, physician and public representation. David Naylor of Ontario's Institute for Clinical Evaluative Sciences, said that the guidelines represented a step forward because "in the past, we have concentrated on the service itself, and whether it should be funded. Now we are seeing an attempt to define when and where a service is useful and to stop paying for it if it is used inappropriately." However, he added, there is also a danger that physicians will be tempted to subscribe more and more of their services to private billings once these are allowed. "They may define what is medically necessary in ways that compromise the patient's interest. Is this also a step on the slippery slope towards privatization of our medical-care system?"
25 August 1993

Private sector growing
A steadily increasing share of Canada's health care system is being financed by the private sector, according to a report prepared by the Canadian Medical Association. "A process of privatization is going on," said Dr. Hugh Scully, chairman of the committee that presented the report to the CMA's annual meeting. The CMA study stated that the private share of total spending on health care amounted to nearly 28 per cent in 1991, up significantly from 25.3 per cent in 1985. The growth in private spending is largely attributed to increasing use of private insurance for services not covered by medicare, the lack of fiscal controls on private charges, and a rapid growth in drug costs. The report points out that more money is now spent each year in Canada on drugs than on physicians. Drug costs, including prescriptions, hospital-dispensed drugs, and over-the- counter drugs, amounted to $11.2 billion, or 16.8 per cent of all health care spending, while physicians amounted to 15.2 per cent. Drug plans, eye plans, and the cost of nursing homes are some examples of where private health care dollars are being spent.
26 August 1993

User fees slammed
User fees are an obstacle to meaningful reform of Canada's health care system -- and they don't work, according to a report prepared by health economists Greg Stoddart and Robert Evans. Neither of the main reasons for user fees -- deterring patient abuse of the system or reducing the cost of medicare -- stand up to scrutiny, according to Stoddart. "Costs will increasingly fall on those who need and use care," he said. The report estimates that less than one per cent of total health care spending is due to patients seeking unnecessary services. Meanwhile, estimates of inappropriate use of the system generated by physicians range as high as 30 to 40 per cent, according to the report. "That is a much larger problem, and one which user charges will not address." There is no evidence that user fees deter patient abusers of the system, according to Stoddart, but there is clear evidence that they deter low-income individuals from seeking necessary medical care. Stoddart also said that it is wrong to expect patients "to diagnose themselves" before deciding whether they need to see a doctor. "How are they going to know in advance what medical services are necessary? Trying to do that may do them harm." Introducing user fees would mean that "the healthy rich stand to gain the most and the sick poor stand to lose the most."
10 September 1993

Drugs trimmed from ODBP
The Ontario government has removed 134 drugs from the list of those provided to seniors and welfare recipients. The changes are expected to save $40 million a year from the $1.2 billion cost of the Plan. Among the drugs removed from the list are calcium supplements, antacids, and digestive enzyme supplements. 36 other drugs were added to the Plan.
13 September 1993

Abuse by nurses found
A survey of 1,608 nurses by the Ontario College of Nurses found that nearly half those polled had witnessed at least one incident of physical or verbal abuse of a patient by another nurse. Half of those said they had witnessed "numerous" incidents. Two-thirds of the reported incidents involved elderly patients. Ten per cent of the reported incidents involved hitting or shoving, 31% "roughness", 28% yelling and swearing, and 28% embarrassing comments. Respondents said patient actions precipitated about 70% of the incidents. The survey did not specify a time period, so there was no indication of how many of the incidents occurred in a given period of time. The College is moving to develop a public awareness program and professional guidelines.
25 September 1993

New Brunswick to privatize administration of health care system
New Brunswick Premier Frank McKenna has announced that New Brunswick's Liberal government will turn over administration of the province's medicare plan to the private sector. Premier McKenna claimed that by handing the administration to a consortium of private companies, the province will save between $12 and $60 million a year. Apparently unconcerned with the government's bargaining position in negotiations with the private consortium, McKenna made the announcement before the government had even received a firm proposal from the consortium. About 80 government employees will lose their jobs. Some will be hired by the private consortium at undetermined wages. The government also announced that it will introduce a personal health card which will be used to feed information into a centralized computer system run by the private consortium. The new system is supposed to help the province track down abusers of the system. The cards will also allow instant printouts of the cost of medical services. The intent is to give each patient a statement showing them the cost of their health care.
29 September 1993

Non-profits to be favoured
Ontario Health Minister Ruth Grier has announced that the government will move to diminish the role of for-profit operators in the provision of long-term care. "The role of for-profit organizations will diminish to 10 per cent of the amount of service that is provided over the next two or three years," Grier said in commenting on a report offering a blueprint for long-term care in the province. Grier said that the aim of the new system is to co-ordinate the 1,200 agencies that provide services for the chronically ill into a new system that will aim at keeping people in their home longer, with one-stop access to services. The agencies will be umbrella organizations working under the guidance of Ontario's 32 district health councils. The agencies will combine home-care and placement co-ordination with the existing services of community groups, such as personal care nursing, home-making, physiotherapy, telephone support and transportation. Grier said some of the new agencies will be operating by 1994, with the remainder coming on stream in 1995.
30 September 1993

"Administrative fees" may go
Ontario doctors could be barred from charging patients yearly so-called "administrative fees" by the end of the year. The Ministry of Health has announced that it intends to move against the charges, which are supposed to be for services not paid for by OHIP, such as renewing prescriptions by phone or writing letters on behalf of patients. However, Dr. Michael Dixon of the College of Physicians and Surgeons of Ontario, warned that the move could actually result in some patients having to pay more, since MDs will still have the option of billing individually for each uninsured service.
16 October 1993

Liberal platform
According to statements made by Jean Chretien during the election campaign, his newly elected Liberal government will not allow the introduction of user fees in Canada's health care system. The Liberal policy document also stated that "a comprehensive re-examination of Canada's health-care spending is required." The Liberals have said nothing about whether they intend to maintain, or change, the existing Progressive Conservative legislation which is aimed at the elimination of all transfer payments to the provinces for health care by about 2002.

Morgentaler wins in Nova Scotia
The Supreme Court of Canada has ruled 9-0 that the Nova Scotia government's ban on free-standing abortion clinics is unconstitutional. The ban was in essence a criminal law, although the government sought to present it as a health policy, the court ruled.
1 October, 1993

Cross-border MDs rate Canadian system superior
A survey published in the November issue of the American Journal of Public Health found that doctors who have practised in both Canada and the United States rate Canada's health care system as superior to that of the U.S. The three main complaints of doctors practising in the United States were the lack of universal access to health care, the greater amounts of paperwork and bureaucracy, and the higher fees charged for malpractice insurance. Higher pay was the main advantage of practising in the U.S., and nearly half of the doctors who left Canada for the U.S. did so because of the pay.
9 November, 1993

Hospital abandons epidurals
McKellar General Hospital in Thunder Bay has abandoned the use in epidural anesthesia during childbirth because of a shortage of staff. The hospital's anesthesia unit made the decision citing under-staffing as the problem. "We're overtaxed," said James Middleton, head of anesthesia at the hospital." "We've had to close one of the operating rooms in the hospital over the last six weeks. I would say at least 120 people have had their surgery delayed in that time. So epidurals are one aspect of the problem, but not the only aspect." Dr. Middleton estimated that McKellar administers between 300 and 400 epidurals a year. The other major birthing hospital in the city rarely administers epidurals, and few of the smaller hospitals across Northern Ontario provide them.
9 November, 1993

Welfare dental cuts cause pain
Metro Toronto's tough measure to reduce dental costs are "causing tremendous pain and suffering" among welfare recipients, according to a report by the West Central Community Health Centre. Metro chopped the dental services budget for welfare recipients to $12 million from $23 million in 1992. But even this lower budget wasn't spent, as welfare workers stopped telling people they were eligible. The result is that only half of the budget was spent. "Not only has the program been stripped to bare bones, recipients haven't even been told they're eligible for crucial emergency treatments," said Dr. Joel Rosenblum, a dentist who works out of the WCCHC.
10 November, 1993

Shortage of radiation oncologists
Bernard Cummings, the chairman of the department of radiation oncology at the University of Toronto, has warned there will be a serious shortage of radiation oncologists in Ontario by the end of the decade. According to Cummings, the number of cancer cases in the province is increasing by 3.5 per cent a year with the result that "we are facing... great difficulty treating the number of patients who would benefit from radiation, and governments are very slow to implement corrective measures. There is a slowness in the process, and during that interval patients cannot be treated." He said 87 radiation oncologists currently are practicing in the province, with another 64 in training at Ontario universities. By the end of the decade, there will be a shortage of 55 oncologists if nothing is done, Cummings said.
11 November, 1993

Staying in bed not that bad
Forcing chronic care patients to stay in bed two days a week "isn't necessarily" compromising their quality of care, according to Lin Grist, a spokeswoman for Ontario Health Minister Ruth Grier. It's understandable that patients at West Park Hospital may be "feeling badly" because social contract cuts means there's not enough staff to help them get dressed and out of bed two days each week, Ms Grist said. "I'm not saying it's a brilliant suggestion but it sounds to me like it was, for them, the least disruptive way of meeting their (social contract) target," she said. Officials at the 398-bed chronic care facility in the City of York are meeting their target of $1.3 million in salary cuts by keeping some patients in bed two days a week.
15 November, 1993

Province backtracks on user fees for drugs
In the face of criticism, the Ontario government backed away from its plan to make seniors pay user fees for prescription drugs. The Ontario Drug Benefit Program pays for prescription drugs for 2.4 million people, including those over 65 and those on welfare. The NDP government announced in June that it wanted to charge user fees to seniors with higher incomes, provoking an angry reaction from seniors' groups and others.
17 November, 1993

Berger chief of family medicine
Dr. Philip Berger, a long-time member of the Medical Reform Group, is now the chief of the department of family and community medicine at the Wellesley Hospital, Toronto. As well as his MRG activities, Berger is chair of the Toronto HIV Primary Care Physicians Group, and a founding member of the Canadian Centre for Victims of Torture.
22 November, 1993

Tenant law broadened
Ontario is extending tenant protection legislation to cover people living in unregulated care homes. About 47,000 people are affected, mainly seniors, former psychiatric patients and people with disabilities. Under the new legislation, tenants in care homes will be covered by the provisions of the Landlord and Tenant Act, which would give residents security of tenure, and the Rent Control Act, which will apply to the portion of the monthly charge that is for rent. Operators of the 2,000 to 2,500 homes affected by the legislation would also be required to register their charges for care and other services with the province's rent registry, and to provide residents with 90 days notice of increases in care service charges. Ernie Lightman, a social work professor at the University of Toronto who wrote a recent report on conditions in unregulated care homes, told reporters that tenant protection was the most important of his report's 148 recommendations.
24 November, 1993

Alberta's user fees
Federal Health Minister Diane Marleau has said that she intends to review the Alberta government's decision to allow private medical clinics to charge patients large sums for operations which are available at no cost in the province's hospitals. The Canada Health Act prohibits doctors from charging more for a service covered by medicare than the amount set out in their provincial fee schedule. Some privately operated eye clinics in Alberta charge as much as $1,000 per patient as a "facility fee" for cataract surgery. The eye surgeon's fee for the operation, about $550, is paid by medicare, but the "facility fee" is not. Richard Plain, a health economist, said this is a clear violation of the Canada Health Act. "This is condoning extra-billing by ophthalmologists rendered under the euphemism of a facility fee. If a service is medically required, such fees are not supposed to be imposed without facing a dollar-by-dollar penalty. "What's happening is that if you go to a hospital for the operation, you face a long waiting list. If you step outside to a clinic across the street, and you've got a thousand bucks, they'll take care of you immediately." Mr. Plain said he is equally concerned about the recent opening of two private clinics in Alberta offering magnetic resonance imaging at $1,000 per scan. "Once again, if you can pay, you get right in," he said. "But any other Canadian, if it's a low-priority matter, will spend months on a waiting list." "The point is that medicare is supposed to ensure there are no financial barriers for access to insured services," he said. "They have no right to impose out-of-pocket expenses on the sick." John Sproule, a spokesman for the Alberta Health Ministry, said the payment of a "facility fee" at eye clinics is no different from the extra fees charged by Alberta's free- standing private abortion clinic. "We pay the physicians for their services and the patients pay the facility fee."
24 November, 1993

Reproductive technologies
The Royal Commission on New Reproductive Technologies released its long-awaited report on November 30. Among its major recommendations, the report recommends restricting in vitro fertilization to women with flocked fallopian tubes; ensuring that all women, including those who are single or lesbian, have equal access to medical procedures, specifically donor insemination; outlawing the selling of babies, embryos, fetal tissue, and sperm, for profit; making it illegal to arrange surrogate births; prohibiting pre- natal testing to determine the sex of a child unless the testing is medically necessary.
1 December, 1993

Millions owed in back payments
The Ontario government is owed millions of dollars in back payments by doctors and not enough is being done to collect, according to the provincial auditor's report. Physicians must repay some of their fees once billings top $425,000. In the past three years, physicians were ordered to repay the province $6.8 million because of overbillings but the province collected only $3.1 million. The auditor's report also complains that MDs face no fine for repeatedly overbilling the province, being forced only to repay the excess money. It also says far too few physicians are referred to the committee that reviews overbilling.
8 December, 1993

Province offers salaries
The Ministry of Health is offering several hundred university physicians a deal that would pay them a basic salary plus extra compensation for such things as overtime or surgery. The Alternative Funding Plan, which has already been agreed to between Queen's University and the province, is also being offered to physicians at universities in Toronto, Hamilton, Ottawa and London. The new faculty payment plan is anticipated to work far better for academic physicians than the current fee-for-service "treadmill," said George McLauchlin of the faculty of health sciences at McMaster University.
22 December, 1993

Midwives join the system
Regulations governing the practice of midwifery in Ontario came into effect on January 1, making midwives a recognized profession under the Regulated Health Professions Act. Publicly funded licensed midwives will now be available for both home and hospital births. Initially about 60 midwives will be eligible to practice. They will be paid a base salary of about $55,000 a year, which can go higher or lower depending on the number of clients and experience. Most registered midwives will not be permitted to take on more than 80 patients a year or fewer than 20. The Toronto Hospital has announced that it will now allow midwives to admit, manage and discharge patients. The hospital plans to appoint four or six staff midwives working in pairs.
1 January, 20 January, 1994

Hospitals propose merging services
Four downtown Toronto hospitals are proposing to form a consortium by merging some services to save money. Under the proposal, Mount Sinai, The Toronto Hospital, Princess Margaret Hospital, and the Hospital for Sick Children would share one biochemistry laboratory, security staff, grounds staff, pharmacy and food units. According to Dr. Alan Hudson, the CEO of the Toronto Hospital, tens of millions of dollars in annual savings are possible.
13 January, 1994

Rural physicians set goals
The Society of Rural Physicians of Canada held its first national executive meeting -- via telephone -- on January 19. "We're discovering that rural physicians across the country have more in common with their rural colleagues than with their urban counterparts who may come from their own province," society president Dr. David Fletcher of Mount Forest said. "Rural is rural regardless of where you live in this country." Goals identified by the group include: (1) The need to respond quickly to rural health care issues from a national perspective; (2) The expansion to a monthly publication of the group's newsletter; (3) The creation of a national electronic mail network to allow continuous communication between members on issues such as hospital closures, physician shortages, and staffing of rural emergency departments. There was a consensus from members across the country that governments are moving from central to regional planning of health care, at the cost of rural medicine. "It means the largest urban centre in your region makes all the rules and sucks the resources out of the surrounding rural area," Fletcher said. "They promise the rural area `outreach programs' in exchange, but the programs last no more than 12 to 18 months. Meanwhile the rural budgets are never returned to the rural area." For more information about the Society of Rural Physicians of Canada, contact Dr. David Fletcher, (519) 323-1951, fax: (519)323-3881.
January, 1994

Dialysis wait called critical
The president of the Toronto Dialysis Committee, Dr. Janet Roscoe, says that a critical shortage of resources for dialysis patients has confined some to hospital and others to severe pain while waiting for treatment. Dr. Roscoe also expressed fears that older patients may not even be getting referred for dialysis because of the huge backlog. The number of dialysis patients in Metro Toronto increased from 504 in 1981 to 1,422 in 1992 and is forecast to keep rising. The increase is attributed to an aging population and an increased incidence of diabetes. Meryl Hodnett, director of patient services for the Kidney Foundation of Canada, said some patients wait so long that they are in a "very poor state" by the time they get dialysis. "People are suffering with symptoms of renal failure and dying as a result of not getting the treatment," she said. In October, the health ministry provided emergency funding to place more people on dialysis as outpatients at two Toronto hospitals. The ministry has ordered a review of dialysis treatment, which is expected to be completed this summer.
22 January, 1994

OHIP curbs
Ontario's NDP government has acted to exclude temporary residents from OHIP coverage. Among those who are no longer covered are about 22,000 foreign workers and their families living in Ontario, and about 19,000 international students. New residents will be subject to a three-month wait before coverage begins, and Ontario residents who have been out of the province for more than 183 days will also have to wait before coverage resumes unless they made prior arrangements with OHIP. People arriving in Ontario who don't plan to live in the province permanently are no longer to be covered. The province is also continuing to press the federal government to pay the health care costs of refugee claimants, but has agreed to reinstate the coverage of refugee claimants whose time-dated health cards expired July 1. Ontario becomes the sixth province to adopt similar measures. Critics have questioned the legality of some of the measures, as well as the practical difficulties of enforcing them. Howard Greenberg, chairman of the immigration section of the Canadian Bar Association, said that he objects to the changes because the workers involved pay taxes in Canada. The Ministry subsequently announced that pregnant women who arrived in Canada before April 1 would be exempted from the policy.
April 2, 1994

Workers compensation reforms
Reforms to the Workers' Compensation Board remain controversial with both labour and employer organizations. The reforms were agreed to by a special labour-management committee created by Ontario Premier Bob Rae to sort out the WCB's problems. The changes, which are supposed to reduce the Board's long-term deficit, were supported by Gord Wilson, head of the Ontario Federation of Labour, a member of the committee, and by Ontario Labour Minister Bob Mackenzie, as well as by employer representatives on the committee. The effect of the reforms, according to the committee members, would be that injured workers will lose money to inflation, but will gain a better chance of returning to their jobs. Under the formula that is at the heart of the changes, workers' benefit gains would lag 25 per cent behind the cost of living, and in addition would be docked 1 percentage point of the inflation rate. Stopping the full indexing of benefits was a key goal of employers in the negotiations. Wilson said that workers gain because the agreement contains a strong commitment to rehiring injured workers. The fully disabled and some workers with the lowest pension incomes are to keep their indexed benefits. The WCB provides about $2.4 billion in benefits and services to more than 200,000 injured people yearly. Some business leaders were critical of the provisions requiring employers to take back injured workers. Buzz Hargrove of the Canadian Auto Workers Union criticized the accord's rewriting of the WCB's purpose. "They're shifting the emphasis away from a program to benefit workers and they're emphasizing the financial end of it," he said. Injured workers' organizations were critical of both the terms of the agreement and the process used to arrive at it. "I don't want somebody else speaking for me. I want a representative of mine at the table," said Don Comi, head of the Niagara District Injured Workers' Organization. "We want to be part of the process".

Mandatory reviews
Alberta doctors will become the first in Canada to undergo regular mandatory evaluations. "It seems pretty clear we're being too reactive instead of being proactive in terms of stopping potential problems," said Larry Ohlhauser, registrar of the Alberta College of Physicians and Surgeons. "The goal here is to fix things before there's a complaint... There's no point looking at a pilot's performance after a crash." The College has yet to determine how it will conduct the evaluations, which each physician will undergo every seven to 10 years. Evaluations will not begin until 1996 at the earliest. Other provinces such as Ontario conduct random peer reviews. Ontario evaluates about 400 doctors each year.
April 6, 1994

Cancer strategy announced
The Ontario Ministry of Health has announced a cancer strategy to combat waiting lists for treatment and to establish plans for cancer prevention. The cancer strategy, called Life to Gain, includes provisions for an additional $8 million for 100 more bone marrow transplants each year, which is expected to eliminate the existing backlog. Additional operating funds will be made available to regional cancer centres to operate radiation equipment. A task force to recommend "appropriate next steps" for cancer prevention is to be set up. A provincial cancer network which will include health care providers, hospitals, agencies, community groups, and patients, is being set up to link services. Ontario Cancer Treatment and Research Foundation president Dr. Charles Hollenberg said he was "very pleased" with the new strategy, calling it "very imaginative and very badly needed."
April 9, 1994

Law could free criminally insane
An Ontario court is being asked to force Ottawa to proclaim a law that would limit the length of time a person can be held in a psychiatric hospital after being found not guilty of a crime because of mental illness. If successful, the constitutional challenge could lead to the release of mental patients who have spent more time in hospital than the maximum sentence for the crimes they were accused of. Advocates for the mentally ill say the law is long overdue, calling the current system of indeterminate incarceration discriminatory. However, Peter Insley, a lawyer representing the British Columbia government, which has been asking the federal government not to proclaim the law, said that "whether a mentally disordered accused should be on the streets boils down to a medical decision. To adopt a legal model undermines that." The case is being brought on behalf of Denis LePage, who has been in the Oak Ridge facility for the criminally insane since 1977.
April 11, 1994

Out-of-country coverage cut
The Ontario government has reduced its coverage of out-of- country hospital stays from $400 a day to $100 a day, saying it needs to save the money. The $400 figure was based on the estimated cost of a one-day stay in an Ontario hospital. "I think that anybody would be very foolish to leave Canada without health insurance," said Ontario Health Minister Ruth Grier in announcing the move. Ontario's action, which violates the Canada Health Act, is being challenged in court by a "snowbird" group, and federal health minister Diane Marleau has said she will takes steps to enforce the Act. Grier said the reduced coverage is in line with coverage provided by Alberta and Saskatchewan, and higher than B.C.'s $75 a day. She said that 140,000 Ontarians received out-of- country hospital care last year. Eric Izzard of the Canadian Snowbird Association said that "The Canada Health Act has a portability clause that says a province must pay the same for health care outside of Canada as they do inside Canada.... "Right now, we feel betrayed by the NDP government."
April, 1994

Pay at the door
A report by the Toronto Star indicates that some Toronto hospitals are increasingly asking patients for cash up front. In several hospitals, patients arriving without a health card are asked to pay $25 on the spot -- the payment being refundable if you show your card to hospital officials within 24 hours. Patients arriving by ambulance are hit with an immediate $45 charge rather than being mailed a bill. Non-residents are also being charged a hefty up front fee for the emergency room. Hospitals charging the fees included Toronto East General, North York General, and Scarborough Centenary Debra Bloomfield, spokeswoman for North York General, said "This is not a revenue-generating thing. We don't even like to process the $25. What we really want is the health card number." East General's controller, Al Kramer, said that each year, about $70,000 worth of admission, emergency and ambulance services at East General are never paid by patients, which means the hospital has to absorb the loss. Non-residents at East General now have to pay a flat $200 fee for the emergency room, which doesn't include doctors' fees, diagnostic tests or anything else associated with the visit. Scarborough Grace charges out-of- country patients $110 up front for an emergency room visit; North York General asks $225.
April 13, 1994

Marleau to enforce Canada Health Act
Federal Health Minister Diane Marleau has cut British Columbia's federal transfer payments because the B.C. government is allowing a groups of doctors in the province to extra-bill, and is looking at similarly penalizing Alberta and Ontario for violations of the Canada Health Act. Extra billing is not allowed under the provisions of the Canada Health Act. Marleau said that B.C.'s transfer payments are being cut by an amount equal to the extra- billing taking place. She is also pressing the Alberta government to account for violations of the Canada Health Act taking place in that province. Alberta has private eye clinics which charge large "facility fees" of $1,000 or more cataract surgery, and has allowed the establishment of private MRI clinics. "Services have to be given to people based on need, and not on the size of their pocket-books," Marleau said. "I am adamant there will be no extra-billing." Ironically, however, Ms Marleau's get-tough approach is being rapidly undermined by her government's failure to reverse cutbacks in federal transfer payments brought in by the previous Progressive Conservative government. The result of these cutbacks will be to eliminate all federal transfer payments for health care within a few years, thereby removing the federal government's enforcement mechanism to ensure adherence to the Canada Health Act.
April 23, 1994

HIV tests for immigrants
Immigration Minister Sergio Marchi says that the government is considering whether to test all potential immigrants for HIV and then deny entry to those who have the virus. At present, people with serious medical conditions like cancer or advanced AIDS may be denied entry to Canada on the grounds that their condition would put a burden on the health-care system.
April 26, 1994

Manning defends extra-billing, user fees
Reform Party Leader Preston Manning has said that he supports the right of provinces to establish private clinics without interference from the federal government. He said provinces should have more flexibility to raise money from private sources. "There is a two-tier system already, not just in Alberta but all across the country. People with money are going to these high-powered clinics in the United States. We're losing them anyway. We're saying, `improve it, by allowing them to do it in Canada instead of somewhere else.'"
April 28, 1994

Drug legislation at issue
Generic drug companies are pressing the federal Liberal government to make good on its promises to reverse or amend the drug patent legislation (Bill C-91) passed by the former Progressive Conservative government in 1992. The generic industry is engaged in a media and lobbying campaign to show that the legislation is costing Canadians hundreds of millions of dollars in additional drug costs. Among the provisions they particularly want revoked is one that made the terms of the legislation retroactive to December 1991, two years before it came into effect. That provision alone cost consumers and provincial governments as much as $2 billion, according to the Canadian Drug Manufacturers Association. Industry Minister John Manley says that the government is looking at the effects of the legislation on prices, and to see if the industry has lived up to its investment promises. For their part, the multi-national brand-name drug manufacturers are once again threatening to pull investment out of Canada if the legislation is changed. However, the new investment promised at the time the legislation was being discussed is proving to be less than a sure thing. In April, Eli Lilly Canada Inc. said it would not be proceeding with the $170 million expansion it announced when Bill C-91 was being passed. John Pye of the Pharmaceutical Manufacturers Association of Canada, which speaks for the brand-name multinationals, said that "forces in the marketplace" are responsible for the fact that the promised investments are not materializing. Bloc Quebecois House Leader Michel Gauthier condemned the Liberal government for even discussing the legislation. He said that just the suggestion of a review of the legislation has caused some companies to put investment plans on hold.
April 28, 1994

Safety inspections called inadequate
A decline in enforcement of workplace safety by the Ontario government is resulting in more injuries and deaths, a union leader has charged. Fred Upshaw, president of the Ontario Public Service Employees Union, says that by significantly reducing the number of inspectors and the number of inspections, the NDP government "comes close to giving employers a license to kill". Government safety inspection staff have been reduced by 25 per cent since 1989, and the number of inspections in the same period has dropped by 40 per cent. The number of directives against employers and stop work orders has dropped significantly, and financial penalties against employers and supervisors declined 69 and 33 per cent respectively. Two figures showed an increase: the number of fines against workers jumped more than 400 per cent over the last four years, while the number of workers killed on the job rose from 232 in 1992 to 292 in 1993. Business leaders immediately lashed out at Upshaw, saying his comments were "irresponsible" and didn't make sense since it is in the interests of companies to reduce job accidents. "I'm offended," said Ian Howcroft of the Canadian Manufacturers' Association.
April 29, 1994

Benefits ruling reversed
Ontario's Divisional court has overturned a decision and ruled that the Ontario Blue Cross does not have to provide family benefits to the lesbian partner of a Toronto nurse. A human rights board of inquiry had ruled last year that Blue Cross had to offer the benefits.
May 3, 1994

Photo ID cards coming
Ontario's Ministry of Health is introducing new OHIP cards that will bear the card-holder's photograph, signature, birth date, sex, name, and address. A magnetic strip will carry the same information in machine-readable form. The new cards are intended to help prevent fraud and misuse. Health Minister Ruth Grier said that the cost of the new cards will be $30 million annually for three years, and then $19 million a year.
May 4, 1994

Payroll tax cut
The Ontario government gave companies a break on employer health taxes in its spring budget. Employers will not have to pay an increase in the health tax if wages are raised or workers added. Instead, a company's tax will be limited to last year's total. The saving will amount to about $600 for a worker being paid $30,000. Finance Ministry officials estimate that the tax break will be worth about $200 million a year, and express hope that the money will be used to create new jobs.
May 6, 1994

Private firms eye medicare gaps
The move by governments across the country to cut back on publicly financed health care is leading private insurance companies to move back into the field of providing health care coverage. Blue Cross launched its campaign in May with full-page ads showing a picture of an Ontario health card with a caption below it reading "This card is full of holes." The ads suggest that costs not covered by OHIP can amount to thousands of dollars a year. Ontario Health Minister Ruth Grier said she welcomed the Blue Cross campaign. "I welcome this debate. It's important for people to have all the information about how much health care should be paid for by taxes and how much paid for by individuals." "There's a buzz out there. There's a lot more interest," said Robin Ingle, president of John Ingle Insurance, in announcing that his company will be offering a comprehensive plan to Canadians providing extended health-care benefits not covered by medicare. "As the gap widens between what the government pays for and what the patient pays for, there's more room for private insurers, and we want to be there with a product. This will be our first such package in 30 years." Mr. Ingle said he believes Canada is headed for a two-tier health-care system, and that he has noticed more and more physicians offering services not covered by medicare. "I've never seen so many entrepreneurial doctors in Ontario before," Mr. Ingle said. "They're opening rehabilitation clinics... providing special cosmetic surgery and other specialized treatments, even penis-lengthening. And they've got people willing to pay."
May 7, 1994

Poor dying younger
Life expectancy for some groups in Britain has worsened for the first time in 50 years, research published in the British Medical Journal shows. The study says there is clear evidence that poverty rather than personal behaviour is the greatest risk to health. The study shows that mortality rates in the most deprived areas of the North are now as bad for some age groups as in the 1940s, and are four times higher than in the most affluent areas. In the poorest areas, mortality rates have risen in absolute terms in men under 45 and women aged 65 to 75, reversing previous improvements.
May 8, 1994

Nova Scotia restructures
Nova Scotia's Health Minister Ronald Stewart has announced a restructuring of the province's health care system. Three hospitals will be closed and services will be cut at 29 others. Some hospitals will lose departments and have to close beds, while others will be converted into community health centres. Hospital workers, like other public sector workers, are being hit with a three per cent rollback in wages and a suspension of collective bargaining.
May 13, 1994

Nurses win racism case
Toronto's Northwestern General Hospital has agreed to pay seven nurses a total of $320,000 and overhaul its management practices to ensure the institution is free of racism, in a settlement reached with the Ontario Human Rights Commission after nurses alleged that assignments, disciplinary actions and promotions were based on racial factors, with white nurses receiving preferential treatment. The hospital did not admit guilt or issue an apology, but agreed to pay the settlement, establish an internal human-rights committee, and give race relations training to its nearly 1,000 staff and volunteers.
May 13, 1994

Hospitals suing gas firms
Hospitals in Ontario and British Columbia are suing five foreign-owned gas firms which were convicted of conspiring to rig prices for compressed gases in Canada. The five companies, Union Carbide Canada Ltd., Air Products Canada Ltd., Liquid Carbonic Inc., Canadian Oxygen Ltd. and Canadian Liquid Air Ltd., paid fines totalling $6 million after they were convicted. Federal competition branch investigators found evidence that the compressed-gas conspiracy existed as far back as 1954, but after plea- bargaining, the companies each pleaded guilty to operating it for one year. The companies admitted to conspiring to adopt a common price schedule; raising prices for existing customers to the agreed-upon level; always quoting prices for prospective customers from the price schedule; refusing to give prices below those on the price list; adopting common transportation prices, and offering no volume discounts. 53 B.C. hospitals and eleven Ontario hospitals have so far launched damages suits against the companies. An industry analyst quoted in the Globe and Mail estimated that the over-charging amounted to $80 million a year across Canada.
May 14, 1994

Drug tab triples
The cost of prescription drugs used by Ontario seniors more than tripled between 1985 and 1993, according to a report, Patterns of Health Care in Ontario, released by the Ministry of Health. Prescription costs for seniors paid for the province's Ontario Drug Benefit Plan (ODBP) rose from $212 million in 1985-86 to $646 in 1992-93. Among the factors responsible for the increase were increased drug use, increased prices, and the replacement of older drugs by newer more expensive medications. Drugs not available in 1985 accounted for almost two-thirds of total expenditures in 1992-93. According to the author of the report's chapter on drug use, Geoffrey Anderson, some of the new drugs, especially those used for cardiovascular conditions, may be less effective and more expensive than those they replaced. "There's some real breakthroughs but there is also a push to use more expensive medications," Anderson said. The report cover prescriptions but not drugs administered in acute-care hospitals. The ODBP now accounts for about six per cent of Ontario's health-care budget, double the share 10 years ago. Other provinces have seen similar increases in the costs of their drug plans. Saskatchewan, the only province whose plan covers its entire population, recently introduced graduated user fees. MRG member Dr. Joel Lexchin said that "asking people to pay more or just not covering their drugs any more are pretty crude methods." "Rather, governments should put their resources into rational prescribing habits. There has to be some mechanism to do this. Newer drugs should only be used when they have clear, demonstrated benefits, and not because they're new."
May 26, 1994

Air ambulance reforms recommended
A panel reviewing Ontario's air ambulance system has said that the system is basically safe, but recommended changes in the way air ambulances are dispatched, in the training and deployment of attendants, and in the availability of aircraft for emergency flights. The panel found that the way paramedics are recruited and trained has led to chronic staff shortages.
May 27, 1994

Unemployment drives health costs
Stress-related illnesses suffered by Canada's unemployed cost the government $1 billion in extra health-care costs last year, according to a study by Dr. Chandrakant Shah of the University of Toronto's preventive medicine and biostatistics department. Shah, who presented his paper at a meeting of the Ontario Medical Association, said that the unemployed are more likely than those with jobs to suffer from heart disease, hypertension, suicidal tendencies, depression, insomnia and other problems. Increased health- care costs come from increases in prescription drugs, such as tranquillizers, hospital visits and trips to the doctor's office, he said. Spouses of unemployed people often have similar health problems and children may show their distress through behavioural problems like hyperactivity or depression, said Shah.
May 28, 1994

Ambulance system said mismanaged
Toronto ambulance workers say that poor management, budget cutbacks, and the effects of the province's social contract are creating serious problems in the ambulance system. Appearing before a Metro Toronto committee, the workers said that response times are increasing and that staff shortages are resulting in attendants and paramedics being required to work longer hours, leading to physical and emotional burnout. Ambulance commissioner John Dean acknowledged that his department is "getting close to crisis" and that many of the workers' complaints are justified. "We have less staff to do the job. We have less cars on the road," he said. But Dean insisted that the system still works and that the public is not in jeopardy.
June 1, 1994

Third-party billing criticized
The Ontario government's decision to require those who request third-party services that are not medically necessary -- specifically sick notes for absences from work -- to pay for them is being criticized by both employers and union leaders. The Human Resources Professionals Association of Ontario says that "transferring responsibility for third- party medical services to employers -- at an estimated annual cost of $75 million -- would seriously impair the ability of Ontario business to regain its pre-recession vitality and create jobs." The association says that if employers are required to pay, they will want the right to choose their employees' doctors and to received a detailed report from the physicians so they will know that an employee's absence is justified. "Physicians who issue certificates paid for by employers should be required, when requested by employers, to provide more detailed information, and employees should be deemed to consent to release of such information." Labour leaders say that employees now often end up paying for sick notes demanded by their employers. Julie Davis, secretary-treasurer of the Ontario Federation of Labour, said that many employers routinely demand sick notes after three-day absences, forcing employees suffering from colds or flu to make unnecessary visits to the doctor, and then to pay for them.
June 8, 1994

Controversy over incorporation
The NDP government's promise, made at the time of its social contract agreement with the Ontario Medical Association, that it will introduce legislation to allow doctors to incorporate is coming under attack from a number of directions. The Health Professions Regulatory Advisory Council has released a report strongly opposing incorporation. The report concludes that incorporation of any regulated health profession is not demonstrably in the public interest, and is in fact potentially contrary to the public interest on a number of grounds. The OMA is insisting that a deal is a deal and that the government is obligated to proceed. Financial analyses have suggested that physicians earning more than $200,000 are the ones who will benefit from the tax breaks associated with incorporation, and that the province stands to lose upwards of $80 million a year in lost income tax revenue. The figure would be likely to increase rapidly since the government would be forced to extend the same privilege to other professionals such as dentists. At present, doctors in Alberta and British Columbia are allowed to incorporate. The Medical Reform Group issued a statement opposing incorporation.
June 16, 1994

AIDS reporting contentious
Physicians who treat AIDS patients have said they will not comply with a controversial new policy of the College of Physicians and Surgeons of Ontario which requires them to report physicians infected with the HIV virus. Under the new policy, doctors treating physicians infected with HIV or Hepatitis B must provide a report to the College, stating whether the infected physician's medical practice should be modified. According to the College's director of policy, Janet Ecker, the College council formed the policy because it feels it needs to "assess whether action needs to be taken to protect the public." Dr. Philip Berger, an MRG member who is on the executive of the Toronto HIV Primary Care Physicians group, said "I won't comply; this is totally unjustifiable." According to Dr. Berger, there have been no documented cases of a physician transmitting HIV to a patient. "They've singled out HIV alone for this type of monitoring," he said. "We don't have to report doctors who have seizure problems, diabetes, untreated mental illness. All of those things can fiercely impinge on how a physician practises medicine, yet none of them have to be reported." Dr. Berger said that "it will drive physicians who may be at risk for HIV underground." Physicians who discover that they have the AIDS virus will forgo treatment, he said. Dr. Berger also noted that nurses and other health care professionals are not subjected to this policy.
June 17, 1994

Consent Act called flawed
The College of Physicians and Surgeons of Ontario is calling on the provincial government to amend certain provisions of the new Consent to Treatment Act which require a "rights adviser" to be called in whenever a patient is deemed incapable of consenting to treatment. College registrar Dr. Michael Dixon said that, while the College supports the principle of the act, its legislative flaws will work against patients. The College wants the act amended so physicians can immediately seek the consent of a family member or substitute decision maker if the patient is incapacitated and the patient doesn't object. As presently drafted, the legislation requires that a rights adviser must be called in first. The College says that it doubts that rights advisers will be available around the clock in hospitals, nursing homes, and clinics, and suggests that the legislation will result in a cumbersome expensive bureaucracy and lengthy delays in treatment.
June 20, 1994

TB on rise in Eastern Europe
After nearly forty years of steady decline, the death toll from tuberculosis is increasing dramatically in most countries of the former Communist bloc. The World Health Organization warns of an impending epidemic, estimating that more than two million Eastern Europeans were infected with TB bacteria in the past five years, and that 29,000 people died from TB last year in Eastern Europe and the former Soviet Union. In Moscow, the incidence of TB has almost doubled in the last two years alone. "This is clear evidence of the failure of TB control programs, which is a real tragedy because TB is so curable," said Kathryn Wilkins, a senior analyst with Statistics Canada who has been monitoring international TB developments.
June 22, 1994

Hospital plans to bill patients for beds
Toronto East General and Orthopaedic Hospital says it intends to begin charging patients who are occupying acute care beds while they wait for a space to open up in a nursing home or a chronic care facility. Patients who don't belong in an acute-care hospital will have to pay $149 a day after they have been in the hospital 21 days. After 29 days, the rate goes to $298 a day, and after 37 days the rate will go to $447, according to hospital spokesperson Sheila McEachen. The hospital says the charges are necessary because the provincial funding formula does not cover the costs of patients' stays. "We have been trying to work with the Ministry of Health on this issue for over a year," hospital president Gail Paech said. "The ministry's response has been silence." Because the government has allowed long- term facilities to increase the number of semi-private and private beds, those who can't afford them end up staying in hospital until a funded bed opens up, Paech said. The Ministry of Health has told the hospital that its planned course of action is illegal. There was outrage among those who would be affected by the proposed policy. "It could take up to six months to get my 85-year-old mother into a nursing home," said Heikki Nihtila, whose mother Marta recently had her right hip replaced at the hospital. "We'll refuse to pay the bill. What are they going to do? Throw her in jail? Make her do community work?" The hospital subsequently issued a statement saying that the policy would be applied to elderly patients who refuse to go to a nursing home that has accepted them. "As soon as someone refuses, the charges go into effect," Paech said.
June 22, 1994

Drug stores fight tobacco ban
Ontario drug store owners are planning to take the province to court to overturn a new law which would bar them from selling tobacco. The legislation introduced by the NDP government would make it illegal to sell cigarettes to anyone under 19, or to sell them in drug stores or in vending machines, as of December 31, 1994. Health Minister Ruth Grier said that her Ministry is banning tobacco from all health-care facilities. Drug stores are considered to be health care facilities because they earn 40 per cent of their profits from the Ontario Drug Benefit Plan, Grier said. Larry Rosen, co-owner of five drug stores, said that "we feel the provincial government doesn't have the right to criminalize the sale of a legal good in only one portion of the retail sector". He said that the bill is discriminatory because 120,000 other outlets will continue to sell tobacco. Rosen said tobacco sales account for 10 to 15 per cent of drug stores' over-all sales, but without cigarettes, spinoff sales will also be lost. He said sales losses could force 140 pharmacies to close and layoffs at many more. About half on Ontario's 2,500 drug stores sell tobacco. An estimated 23 per cent of tobacco sold in the country is distributed through drug stores. "Here we have pharmacists going to court to protect the right to sell the Number 1 cause of disease and death in this country. We think this is nothing short of pathetic," said Michael Perly of the Campaign for Action on Tobacco. Gar Mahood of the Non-Smokers' Rights Association argued the challenge is essentially driven by Shoppers Drug Mart, a subsidiary of Imasco Ltd., a major tobacco manufacturer.
June 22, 1994

Money for community care
The Ontario government has announced that it is diverting $29 million from institutional care for people with developmental disabilities to community care and local support services. At present, the government operates nine institutions for the developmentally disabled, serving 2,571 people at a cost of $286 million. 30,000 people with developmental disabilities and their families use government-funded services provided by more than 380 non- profit agencies, at a cost to the government of $609 million. "This is not going to solve the problem, but it will help," said Ken Haggerty, director of an advocacy agency for the developmentally disabled. "The most significant part of the announcement is that money saved from the shutdown of institutions will stay in the sector."
June 22, 1994

Call for assisted suicides
The AIDS Committee of Toronto (ACT) is calling on the federal government to amend the Criminal Code to allow for assisted suicides. ACT board member Alan Stewart said that only a small proportion of the AIDS sufferers he has known choose suicide, but the availability of the option provides solace that they can end the pain and indignity if it gets too severe.
July 6, 1994

Hospital cuts called haphazard
Cuts to hospital operating budgets have been haphazard and have resulted in longer waiting lists, elderly people being stuck in acute care beads while waiting for chronic care beds to become available, and families being burdened with sick parents at home, according to a review by the Metropolitan Toronto District Health Council, which reviewed the operating plans of 43 hospitals. The review said that many administrators did well at making cuts to their institutions, but since no one was co-ordinating the cuts over-all, hospital administrators unwittingly left gaps in services, often affecting the most vulnerable. According to Lorne Zon, executive director of the Council, the result has been growing waiting lists for those seeking help in mental health and addiction services; major problems with access to radiotherapy, chemotherapy, palliative care for the dying and bone marrow transplants; insufficient paediatric and adolescent services; and extensive waiting lists for dialysis. Patients are being discharged from hospital sooner, leaving parents looking after sick parents and children in their own homes. A growing number of elderly patients are being housed in acute care hospitals while waiting for spots in chronic care facilities.
July 7, 1994

Morgentaler in court again
Dr. Henry Morgentaler is going to court to challenge the New Brunswick government's ban on free-standing abortion clinics. Dr. Morgentaler performed five abortions at his new Fredericton clinic at the beginning of July in defiance of the law. The New Brunswick College of Physicians and Surgeons then restricted his license after being requested to do so by Health Minister Russ King and called a board of inquiry to determine whether Dr. Morgentaler committed professional misconduct. Under New Brunswick law, abortions are permitted only in three accredited hospitals and only with the approval of two physicians. "I blame the government for this absolutely useless fight and waste of taxpayers' money", Morgentaler said.
July 14, 1994

Plain packaging
Tobacco companies are mounting a vigorous campaign to derail proposed plain packaging regulations. Federal Health Minister Diane Marleau announced in April that she planned to introduce legislation requiring plain packaging for cigarettes. The move was seen by anti-smoking activists as an attempt by the Liberal government to regain some of the credibility it lost with public health groups after it lowered cigarette taxes earlier this year. They caution, however, that Marleau will need to line up other cabinet members behind her initiative if legislation is to be introduced. Tobacco industry executives like Michel Descoteaux of Imperial Tobacco Ltd. insist that plain packaging is a futile measure that "will have no impact on our sales", but are simultaneously lobbying furiously to stop the plan dead in its tracks. The industry argues that a plain-packaging law would violate "corporate freedom of speech" and would amount to a state-sponsored seizure of a company's trademark. Proponents of the legislation say that such a law would be a reasonable limit on tobacco companies, given that an estimated 40,000 people in Canada die prematurely each year from illnesses caused by tobacco.

Iraqi drugs shortages
Severe shortages of drugs in Iraq are being reported by the medical charity Medical Aid for Iraq. According to MAI, supplies of drugs are now at far lower levels than after the Gulf War, and hospitals are struggling to manage without antiseptics, incubators, anaesthetics, needles, antibiotics and drugs of all kinds. Medical aid is supposed to be exempt from the sanctions imposed by the United Nations after the Gulf War, but aid agencies have complained of considerable practical difficulties in ensuring supplies. MAI reported shortages for medicines for children with chronic diseases such as diabetes, asthma and epilepsy. Intravenous drugs are especially scarce, and antibiotics are being given in half measures.
July 24, 1994

Kickbacks alleged
The Ontario Ministry of Health is investigating allegations that a private medical laboratory is paying kickbacks to doctors. The Toronto-based lab is alleged to have paid individual doctors in five communities up to $3,000 a month each in exchange for routing patients to the lab for testing.
July 24, 1994

Healthy newborns
The federal government is setting up a program to help low- income women get the proper nutrition and prenatal care needed to give their babies a healthier start in life. The government will spend $85 million over the next four years providing counselling, education, and food supplements in an effort to reduce the number of low-birth-weight babies born in Canada. It is estimated that about one-third of low- birth-weight babies owe their condition to preventable, poverty-related factors. About 21,000 babies weighing 2,500 grams or less are born each year in Canada. The program is to be community based, with groups able to apply for funding under the program.
July 27, 1994

Fewer MDs bill over $400,000
The number of physicians billing OHIP for more than $400,000 a year has dropped sharply. This year, 581 physicians billed OHIP more than $400,000, compared to 827 in the 1992-93 fiscal year. 130 billed more than $454,500, compared with 199 in the previous year. Under an agreement between the government and the Ontario Medical Association, physicians earn 66 cents on the