Bulletin: Doctor takes night calls
From the Editor
The province of British Columbia is conducting a useful pilot project to determine if a health information hotline in Victoria will cut down on unnecessary visits to the emergency ward. The cost of the study is $600,000. What that means is that more than 25 such projects could have been funded around the country for the amount of money that the federal government was prepared to dole out to the NHL’s fat cats last week. And take the real money the federal Liberals spilled on poorly supervised job-creation schemes—at a time when there is a chronic shortage of doctors and hospital beds. What Canadians saw last week was the Chretien government’s total disconnect from the lives of the people. Clearly, leadership ambitions overcame judgment, as ministers flamed out. Industry Minister John Manley dropped his proposed NHL welfare bum fund. And Human Resources Minister Jane Stewart, a putative leadership aspirant herself, had to fess up that her $ 1 -billion jobs program was a mess.
All of that was a long way from the reality in the downtown Toronto offices of Dr. Fred Freedman, a general
practitioner who is one of the movers in a small movement that is trying to do something to improve the delivery of health care. In his profession, Freedman’s commitment is controversial and criticized: he is among a minority of Canadian practitioners who does not charge separately for each visit— known as fee-for-service—his patients sign up (known as rostering) and medicare pays him a monthly fee averaging $10 no matter how many times they come to the office.
Freedman is part of a program started in the late 1970s by the Conservative government of Bill Davis. Maligned as the program is in some quarters, one advantage is that Freedman and two colleagues guarantee that someone is available 24 hours per day when a patient calls. Unlike most docs, they do not automatically refer patients to hospital emergency rooms after hours.
Many doctors oppose rostering because they don’t want to work for a salary. Critics also say the system encourages “skimming,” with physicians taking on only healthy patients, and delivering fewer services to patients to save time and money. Freedman coun-
ters: “We can’t turn away people just because they are going to see us a lot.” He also points out that if there is a financial incentive, it is that the better the health of his patients, the fewer visits they will make to the doctor. A bonus for patients—and budgets in the health system—is that phone consultation is much more common; calls are not covered in the fee-for-service system. For government and physicians, the key is predictability: the cost of a rostering system can be set at the start of each fiscal year and the doctor knows exactly what his income will be.
It may not yet be an idea whose time has come. But rostering clearly is another tool in the effort to untangle the complex issues of the health-care delivery system. It is time for the Liberals in Ottawa to stop their underground leadership campaign and start dealing with real issues—like life and death.
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