Canada's Single Payer/Single Problem
By David Henderson
Have you seen this sign in your doctor’s office? It reads, “One problem per visit, please.” An editorial in the Canadian Medical Association Journal says this sign is popping up in the offices of some family physicians.
This is from W. Gifford-Jones, M.D., “It’s only one problem, but it’s a big one,” Winnipeg Free Press, January 17, 2009.
I was in Winnipeg last week to interview my first mentor, Clancy Smith. He mentioned that it is increasingly common for doctors to have signs in their waiting room telling patients that they are allowed to mention only one ailment per visit. Clancy said that he had heard of one sign that told patients that if they mentioned more than one, the appointment would be ended immediately. I told my wife about it, who found the link above.
Why does this happen? The government has a fee schedule that pays doctors for specific problems handled. I’m guessing that if they have a patient for an appointment, the doctor can name only one problem on the form that generates the payment.
For my chapter on Canada’s rationing by waiting, see David R. Henderson, “The Inefficiency of Health Care Rationing–and a Solution,” in Steven Globerman, ed., Reducing Waiting Times for Health Care: What Canada Can Learn from Theory and International Experience.
UPDATE: A message from a doctor friend causes me to think that I didn’t make my point clearly. My point is that doctors can charge for only one thing and, therefore, want the patient to make multiple appointments to maximize charges.