The medical fee (fee for service) negotiation processes of several Canadian provinces (- to 1978).

Abstract

The method whereby fees are set for medical services is of significant relevance to the operation and overall total cost of a health care delivery system. Until the advent of medical insurance, the setting of fees was traditionally a matter for the profession. Although many of the early medical insurance organisations were physician sponsored, the profession began to lose its autonomy as these insurance bodies became involved in the process. With the introduction of medicare the setting of fees became a joint government and profession matter with fees, for medical benefit purposes, being set by negotiation. It may be argued that by 1978 the Government had assumed responsibility for medical fee setting in many Provinces. The purpose of this paper is to review the conduct of fee negotiations in five provinces---Alberta (in depth), British Columbia, Saskatchewan, Ontario and Quebec---up until 1978. In the first chapter the purpose is further defined and explained, while in the second the method to be followed is developed. The third chapter is devoted to a review of literature relevant to physician behaviour in relation to fees and income. As an introduction to the chapters dealing with the individual Provinces the fourth chapter develops a set of possible objectives for the profession and the government in the fee negotiation process; this reference set is provided to allow the reader to access the conduct of negotiations in each Province. The individual provinces are dealt with one by one in Chapters V to IX. In the final chapter the conduct of fee negotiations is discussed.