The medical profession and health insurance: An Ontario case study

Abstract

Government health insurance programs in Canada represent innovations in public policy which are economic and social in nature. Initiated as cost-sharing agreements between the federal and provincial governments their purpose is to transfer responsibility for the direct costs of health care from the individual to the public purse. Within the provinces an equalization of costs as between high and low risk groups is sought by spreading the financial burden for plan solvency across an entire population. Provincial plan revenues derive from general taxes, special earmarked taxes, premiums or a combination of the above. The federal contribution under prevailing fiscal agreements is calculated at roughly 50~o of each province's costs for specified hospital and medical services [1]. Health insurance plans are social in their aims since they represent part of a broader movement in industrialized societies to extend certain basic social rights to progressively wider strata of the population. The programs are designed to have a direct impact on the welfare of the nation's citizens by eliminating the influence of income as a restraining factor on desire for health care. Implicit in this process is a concept of health care as a social right which should be equally available to all regardless of ability to pay and which comprises an essential component in the status of citizenship [2]. The full implications for public policy of government health insurance measures are still evolving. Two emergent trends seem especially significant. First, through the medium of public accountability for the costs of health care. governments have found themselves assuming progressively greater responsibility for the organization and quality of health services. Second, from the premise that the goals of public policy with respect to health basurance should be directed towards the welfare of all groups, an emergent concern with the concept of social equity in health care has evolved. John Munro, a former Minister of National Health and Welfare in Canada, gave explicit recognition to these forces when he stated of government's expanded role in health affairs, We must ensure the right care to the right person at the right time in the right place and at the right