By MARK WYMAN

How come the cost of hos-
pital and medical care in Ca-
nadian hospitals has risen so
sharply? Why is the per capi-
ta cost of hospital insurance
going to $88 (up 25 per cent)
and the per capita cost of
medical care increasing by 32
per cent to $64?

Some people — mainly pri-
vate enterprisers and doctors
— say it’s because insured
people are being “pampered”
by an “over-use” of services.
(This, in plain English, means
that sick people are getting
proper treatment now, and
were missing it when there

weren’t Hospital and Medical
plans).

HAROLD GREER |

But Toronto writer Harold
Greer, in two articles in the
Peterborough Examiner, has
uncovered the real reason:
it’s the doctors who are driv-
ing costs of care up.

That’s who. But how are
the doctors doing it? To un-
derstand how, it’s necessary
to become familiar with some
very modern medical prac-
tices.

Hospitalization costs are in-
creasing because, nowadays,
doctors are ordering more
diagnostic services for their
patients. Greer gives this ex-
ample: between 1960 and
1966, the number of diagnos-
tic X-rays increased by 58
per cent, and the number of
units of hospital laboratory
work by 103 per cent.

More services mean more
staff. While admissions went
up 17 per cent, full-time hos-
pital staff increased 38 per
cent and part-time staff 67
per cent. Total paid hours
worked went up 40 per cent.

As a result, per day cost of
hospital care averaged $22.57
in 1960 but $35.84 in 1966. Of
the latter figure, wages and
salaries accounted for $23.85,
and only half of that was for
nursing.

NEW DEVICES

New devices like kidney
dialysis machines, special cor-
onary units, etc., cost money
too. But some doctors, accord-
ing to Greer, admit that many
’ procedures, “such as X-rays,
have become routine for all
patients regardless of need;
after all, it’s not going to cost
the patient anything, so why
not order it anyway?”

And perhaps that’s why
Canadian hospital costs go up
22 per cent a year, compared
to 15 per cent yearly in the
U.S., where medical tech-
niques are just as modern.

So much for hospital costs;

now let’s look at the price of \

medical service itself — that
which is paid for by the On-
tario Medical Services Insur-
ance Plan (OMSIP), which
covers almost a third of the
province’s population.

Greer gives the following
interesting case-study: pa-
tients needing an angiogram
(injection of dye into an ar-
tery, ete.), used to have it

done by the hospital radiolo-
gist; it was an insured hospi-
tal service.

Now, however, neurologists
and internists do the injection
themselves and charge the fee
— and the Ontario Medical
Association hiked its rate from
$40 to $50 for the service,
calling it a ‘diagnostic pro-
cedure!”

DOCTORS TOO

Well, radiologists are doc-
tors too, and now they also
bill OMSIP for the high rate,
or anyway for the 90 per cent
of it that OMSIP pays.

In the same way, medical
staffs of hospitals used to take
care of poor people free. The
hospital got $2.25 per visit
from the Hospital Services
Commission.

But since OMSIP, welfare
patients are charged for “of-
fice” calls. — and thus the
cost to the public isn’t $2.25
per visit, but $6.75 and up.

Add to that the trend away

from house calls — and the
difficulty of finding a doctor
on a weekend! — and you

get people going to the hos-
pital when once they'd have
called the family doctor.

MACHINE MEDICINE

And the hospital is where
the latest scientific equipment
is. “Machine medicine,” Greer
calls it — and shows how it,
too, is used by doctors to up
the per-patient cost of medi-

cal care.
The frequency of office
calls has gone down — the

doctor sends the patient for

_diagnosis to the hospital,

where the fancy equipment
is. And thus, the frequency
of diagnostic X-rays has in-
creased 57 per cent in five
years; other diagnostic pro-
cedures, 70 per cent; labora-
tory analysis, 650 per cent.

Across the board, out-
patient visits and treatments
in Ontario hospitals rose 87
per cent in the five years.

Nobody’s suggesting that
every patient shouldn’t be
able to have all the latest
machines to help diagnose
his ailment — but it’s how
doctors use the -procedures
that makes the cost . differ-
ence.

With the government (that
is, the taxpayer) paying for
health care for poor people,
doctors'on the staffs of hos-
pitals have been forming
“associations” or legal part-
nerships to bill out-patients
for professional fees. Why

not? The government will pay
the shot!

MONEY INTO POOL

The money goes into a pool
which is distributed to the
member-partners; the associa-
tions apparently don’t pay
the hospitals for the use of
the facilities. And the mem-
bers hire hospital residents
and internes to do much of
the work, which happens to
be a way of getting around
the College of Physicians and
Surgeons regulation that only

DOCTORS RESPONSIBLE FOR HIGH MEDICAL

those on the College Register
can charge fees...

And the hospitals them-
selves, faced with rising in-
patient costs, also bill out-
patients, again on the theory
what the out-patient. “doesn’t
pay,” the government does.

“Robbing Peter to pay
Paul” is what Greer calls it.

The best example he gives
is of the semi-automatic mul-
tiphasio autoanalyser (SMA)
a gadget which performs 12

- different chemical tests at the

same time on a single blood
sample. The cost of the tests
is 30 cents.

BIG SAVINGS

That should mean big sav-
ings, because before the ma-
chine was developed, each
test had to be performed man-
ually. But the savings haven’t

materialized — in fact, the
opposite is true.

How come? Because hos-
pitals, which used to charge
out-patients nothing (why
send a bill for 30 cents?)
were pressured to levy a fee
— and the fee is $5 for two
or fewer tests, $12 for three
or more. But the machine
does all the tests anyway, and
doctors tend to just write
“SMA” on their orders.

Result? Twelve bucks
charged for something that
costs thirty cents.

This business of “machine
medicine” has resulted in the
formation in one year of over
200 doctor-owned ‘corpora-
tions” to operate medical labs.

Why? Because OMSIP is
based on the doctors’ own fee
schedule, and the fee sched-
ule calls for healthy fees *(par-

don the pun) for diagnostic
tests.

LOCAL 1-217 PRESIDENT
RETURNED BY MEMBERS

Syd Thompson, president of
Local 1-217 IWA Vancouver,
won an overwhelming victory
over his opponent Len Cat-
ling, in the recent referendum
ballot conducted for the posi-
tion of president of the Local
Union.

Thompson’s office was the
only position contested in the
Local elections. Returned by
acclamation were Tom Clarke,
1st vice-president; Bob Clair,
2nd _ vice-president; Gordon
Paterson, 3rd vice-president;
Doug Evans, financial secre-
tary; George Kowbel, record-
ing secretary; Bob Blanchard,
conductor; Hector Poirier,
warden.

SYD THOMPSON

And Greer points out that
the actual work is often done

by a technician (‘often the
doctor’s wife in the next
room”), but the “corpora-
tion” — the doctor under an-
other name — sends the bill.

So the patient gets two
bills — one for the medical
consultation, one for the lab
work — and OMSIP pays 90
per cent of each, and the cost
of medical care rises when it
shouldn’t.

As a parting shot, Greer
says that the salesmen who
peddle the SMA machines to
doctors say, in effect, “Buy
now and recover the capital
cost within a year.”

The capital cost of a small
one is about ten thousand
dollars!

But after all, why not? The
“government” is paying the
shot. Who cares if cost of
medical service goes up? The
doctors can always blame it
on “pampered patients’? who
get “too much service.”

BEST WAGES
IN SARNIA.

Industrial workers in Sar-
nia remain the highest paid in
the country according to the
Dominion Bureau of Statis-
tics.

Average weekly wage of
Sarnia workers was set at
$133. In second place was
Oshawa with $128.69 and
third Sudbury with $123.31.

. Other cities in the top ten
were: Windsor $121.08, Wel-
land $120.86, Chicoutimi
$120.12, Sault Ste Marie
$119.88, St. Catharines
$115.21, Peterborough $111.42,
and Vancouver $111.00.

In eleventh place was
Hamilton with $110.36 and
Toronto twelfth with $108.10.

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