Re: off topic: eyecare economics

"William Stacy" <wstacy@xxxxxxxxx> wrote in message
news:xkAKe.2795$Z87.1911@xxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> Wow! Thanks for the extensive review. I'll cut and paste my way through
> to a few observations and questions I have:
>
> Dr Judy wrote:
>
>> Health care in Canada is private delivery, public pay, it works like one
>> insurance company with everyone living in the country insured. Instead
>> of individuals paying premiums, the insurance is covered by taxes.
>
> Would that be an income tax, or some other? Any idea what % of income or
> whatever source the program costs?

There is no special tax levy for health care. Government revenue is mostly
income tax, though there are also sales taxes, duties etc. All government
revenue is pooled and all government expenses including health care costs
come out of the pool. I think health care costs, including drugs, home
care, nursing homes (drugs for everyone over 65, drug costs in excess of
$1000/yr per person, cost of home care for all, cost for basic 4 per room
nursing home is about 20% to 25% of government expenses.

The cost of providing health care in Canada including drugs, nursing homes,
gov't insured and non insured services is about 9% of GNP. The similar
number for US (remembering that about 40 million Americans are not insured)
is about 13% of GNP.

>
> No one is
>> denied coverage based on pre existing conditions.
>
> I love that part.
>
>
>> Doctors maintain their own offices, hire and pay their own staff, and pay
>> their own overhead out of the fees paid by OHIP. If a doctor wants to
>> make more money, he or she can cut office expenses or work more hours.
>
> What about offering more non-covered items? I mean couldn't a doc buy a
> retina camera and take pictures for a fee, esp. if he/she knew it would
> not be covered by ohip?

Yes, and we do.


>> Doctors can opt out of OHIP and charge patients directly for insured
>> services, however they are forbidden by law to charge patients more than
>> the OHIP rate.
>
> So why would they, and do any?

A few people did in the early years, just on principle because they were
opposed to socialized medicine. It makes no financial sense since you
charge the same fee and have added on the collection costs.

>
> Doctors are free to provide uninsured services to patients, and
>> can charge any fee they want, but the patients, not OHIP, pays for them.
>
> Are glasses, contacts covered, and under what circumstances/limits. Can
> patient purchase more expensive items than are normally covered? I think
> you once stated that doc's can't profit from "sale" of eyewear or
> contacts, but opticians could. Is that right? Seems unfair to me,
> although I'm aware of the potential conflicts of interest in our system.

Glasses etc are not covered by OHIP. The patient is always free to pay for
uninsured items. Social services covers the cost of glasses but not
contacts for those on social assistance or on disablity. Contacts can be
covered for those on social assistance in rare conditions, for example,
aphakia or keratoconus.

We not forbidden to "profit", but we must provide materials for a fee, not a
markup. All health professions have this rule. For example, when I go to
the dentist for a crown, he charges a flat fee for crown prep and his
actual invoice cost of the crown, when I go to the pharmacy, the pharmacist
charges a flat fee for dispensing and his actual cost of the drugs and when
someone gets glasses or contacts from me, I charge a flat fee for fitting
and my actual cost.

>
>
> Refraction is
>> specifically excluded as a reason for an insured exam of a person between
>> 20 and 64, refraction is covered for the other age groups. Optometrists
>> bill the patient for uninsured services like refraction and for health
>> assessment when no problem is found.
>
> Does ohip pay separately for refraction and exam when disease is present?
> If so, what's the breakdown?

No. If refraction is necessary for diagnosis of the condition it is
included in the exam fee. If the only reason a person between the ages of
20 and 64 presents is for refraction, OHIP doesn't pay anything. If during
the course of an exam, a disease is discovered, then the visit is covered.
>
> It bogs down for elective
>> care like cataract, where delays, although annoying do not result in
>> morbidity or mortality.
>
> Is it illegal for a doc/patient to go around the system and do a cash deal
> for surgery that is not "covered"? E.g. questional cataracts or outright
> clear lens exchanges. If ok, are the fees limited?

Clear lens extraction for refractive reasons is not insured so it can be
billed to patient. But if the reason for surgery is cataract, even if
questionable, then it is insured and OHIP must be billed, not the patient.

>> As far as quality goes, various studies have shown that the Canadian
>> models delivers better quality at lower cost
>
> Tough thing to measure, medical quality, so I'm not convinced one way or
> the other on that, but for sure more people (%) have access to medical
> care up there than down here, which is why I hope we go toward your
> system. I'd just hope that they leave room for private initiative and
> freedoms to choose.
>
> Thanks for the post and for any additional answers you might care to give.
>
> w.stacy, o.d.


.

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