Polls point to growing gap between MDs, patients over financing of health care

An unprecedented round of CMA polling points to some startling differences in the way physicians and patients perceive the financial problems facing Canada's health care system. One poll indicates that doctors consider recent federal budget cuts a sign that the private sector will soon have a major role to play in health care financing. However, a poll of nonphysicians shows that Canadians oppose any move toward “out-of-pocket” payments for health care services, including payments for private insurance. The CMA board has responded by turning much of the 1995 annual meeting over to the topic of the future of health care in Canada, including financing, and the medical profession's response.     

Physician supply in Ontario: further observations on SHARP and the SHARP projections.

In this issue (see pages 1395 to 1398) Eva Ryten questions the validity of the data that supported the projection of a surplus of physicians in Ontario over the next two decades, as presented in an earlier article in CMAJ by Denton, Gafni and Spencer. The authors maintain that the data they used were appropriate. Although the average annual growth rate for the early 1990s calculated from Ontario Health Insurance Plan (OHIP) billing data is somewhat lower than the rate they projected for the decade as a whole, the OHIP-based rate is much closer to their figure than Ryten's rate. They also disagree with Ryten in their belief that the recent reduction of medical school enrollment will have a negligible effect on the physician population by the year 2000. They argue too that Ryten misunderstands the nature of the imbalance they project between the availability of intern and resident services and the requirements for those services. Finally, the authors note that there is an argument for setting requirements for practising physicians at levels lower than they had assumed. For that reason, even if the supply of practising physicians were to grow less rapidly than projected, a substantial surplus could still result by the year 2000.     

Occupational Dermatoses in Ontario, 1955 to 1962

In Ontario in 1962, with a compensationeligible labour force of 1,814,000, 10 out of each 1000 workers received compensation for some occupational dermatosis, as defined here; 36 out of each 1000 workers received compensation for some cause. Contact dermatitides made up 5042 of 7448 cases of occupational disease for which compensation and/or medical aid was paid in 1955 and 1956. In eight years, 1955 to 1962 (inclusive), of a total of 534,557 “compensation only” cases, 7023 received payment for contact dermatitis. The average yearly cost of compensation of a worker with a contact dermatitis was estimated at $1113; the annual total cost, at $900,000. The average cost of an occupational dermatosis was $368; the annual total cost, $10 million. Occupational dermatoses account for almost one-third of all compensation costs. The cost of “medical aid only” is excluded from all of these estimates. In contact dermatitis, primary irritants (chemicals) are still the main causative agents. Skin sensitizers, the epoxy resins particularly, have become more prominent in recent years. There is no all-purpose barrier cream or protective clothing. Proper personal hygiene remains the most effective preventive agent in industry.     

Concern over fraud causes Ontario to invest $90 million in new health cards.

In an attempt to stop fraudulent use of Ontario's health care system, the province will soon begin issuing health-insurance cards containing the holder's photo. It is not known exactly how much fraud costs the system, but the cost may exceed $100 million annually. Dr. John Carlisle, deputy registrar of the College of Physicians and Surgeons of Ontario, warns that the government must be prudent in designing a system for reporting suspected health-card fraud.     

Impact on health care adds to the social cost of homelessness, MDs say.

Homelessness has become a visible part of Canada's urban landscape, infecting adult men and women, youths and families with children alike, and the issue becomes particularly serious as winter approaches. During a workshop in Toronto earlier this year, physicians, researchers and social workers examined the effects of homelessness on health, identifying many of the unique health needs of this vulnerable segment of society.