Assess role of doctors

Your editorial, Turbulence in health (July 22), suggests that among many actions the Health ministry may undertake to reduce the overwhelming cost of medicare is to compress administration to one or two health regions, and squeeze every nickel of productivity from existing resources.

Re-introducing user fees and possibly funding only half of agreed pay agreements were also mentioned.

However, the ongoing discussions don’t include any significant assessment of the activities and costs of those who drive the whole system: the physicians.

Many studies here, by the Health Quality Council, and elsewhere have shown that, for example, many MRI and CT scans are unnecessary. Perhaps private MRI clinics aren’t needed. There are many procedures that vary greatly in incidence from hospital to hospital. This was demonstrated in the 1970s, when the rate of hysterectomies seemed to depend on which surgeon provided the service. Once this became public knowledge there was significant reduction in this procedure.

Then there is the cost of physician services. Many would be surprised to learn that in 2014-15 at least 13 physicians received $1 million in medicare payments, with an orthopedic surgeon paid $2,24 million.

Ontario has made some effort to contain payments to physicians but has been met with threats of doctors leaving for greener pastures. Such threats could be countered if the premiers meeting in Whitehorse could have agreed to a national effort to get a grip on the cost of physicians.

It’s not only the money they receive that’s the problem. The costs that their actions generate also need to be reviewed. This is a touchy subject, as government interference in how physicians practised was a factor in the doctors’ strike in 1962 to prevent the initiation of medicare.

I believe the government should appeal to the College of Physicians and Surgeons to investigate variation in procedure rates, the proper use of technology and the disparate rate of payment among medical specialities. Such an investigation might provide assurance that we are getting value for money. Dr. John Bury, Saskatoon