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March 31, 2016

In the March/April 2016 edition of it's publication "College Connector", the College of Physicians and Surgeons of British Columbia published the essence of the reply it sent to me with respect to "One Issue per Visit" signs and policies. Please read it at: "The sign says, one issue only per visit. But is that OK?"

March 16, 2016

Click here to see the response from Dr Wilson to my letter copied below.

One Issue per Visit

March 5, 2016

Dr. Galt Wilson
Senior Deputy Registrar
College of Physicians and Surgeons
of British Columbia
300 -669 Howe Street
Vancouver BC V6C 0B4

Dear Dr. Wilson:

Your presentation at the Walk-in-Clinic conference was the highlight of the day. Thank you for being so clear. I am writing to verify what I heard and to ask that the College’s position be posted as a standard or guideline.

When you took questions, a clinic manger from Kamloops asked if she could ask physicians at her clinics to restrict office visits to one issue per visit. You said no and went on to describe how physicians could find themselves in trouble if they did that and in particular trouble if they had signs in their office notifying patients that they had a policy of one issue per visit.

Following the conference, I searched the College's website to see if I could find anything that offered the caution you gave. Not finding anything, I broadened my search and on the Doctors of BC website (at I found:
"Some patients in BC may notice a sign at their doctor's office that limits the amount of questions they can ask in a medical visit to one. These signs are generally an office-byoffice, clinic-by-clinic decision that the doctor has made in order to reduce backlog and decrease waiting times."

"The College of Physicians and Surgeons of British Columbia, the regulatory body for medical practice in BC, says that many doctors have established a "one issue per visit" policy in order to assist them with time management and patient scheduling due to a heavy roster of patients."

"Dr Bill Cavers, past president of Doctors of BC, explains that while he doesn't like to use a sign, he does tell his patients that there is a time limit and they will have to focus on the most urgent problems for that day."

"He recommends to all patients that they be aware of time and present the doctor a written list of all health issues before the visit. The doctor can then read over them and decide if the issues are related or if some of them should be examined during the visit."
That statement on the Doctors of BC website verifies my sense that the practice of "one issue per visit" signage is common. The likelihood that all, or even most, patients are capable of presenting a physician "a written list of all health issues before the visit" is slim, and it is my opinion, those words weakly attempt to avoid the legal and ethical issues involved in "one issue" policies.

Last fall I phoned a clinic to book an appointment for my annual flu shot and requisition for blood work to monitor my cholesterol, something that usually takes about 5 minutes. I was told that two appointments would be required. I havent been to the clinic since and I sent a complaint to the Medical Services Commission asking them to investigate billing practices at the clinic. While my issue was one of cost and convenience, as you noted, there can be serious health consequences if the one visit policy results in some patients not reporting symptoms or in symptoms being ignored.

Please confirm what you told that clinic manager at the March 4th conference regarding "one issue policies" and signage. I believe as a matter of public interest and protection, those words should be added to either a standard or guideline on the College's website.


David D. Schreck

February 18, 2016

MSP Tax Shift

What we pay for MSP is a tax, not a premium as the government would have us believe. It is a tax because there is no connection between paying it and being able to use your health card to see a doctor and because they send a collection agency after you if you don't pay it. Unlike a premium you don't have the option of saying no thanks, I don't want it (unless you agree to accept full responsibility for all your health costs under terms most rational people would reject).

In its 2016 budget, the Clark government announced changes to the MSP tax effective January 2017, four months prior to the next election; unfortunately, the changes will make it even more inequitable.

In 2016 the monthly MSP tax is $75 singles, $136 couples, and $150 families of three or more. Reduced taxes are available for those whose adjusted family income is less than $30,000. The adjustments are additional allowances of $3,000 for each child, for handicapped and for each senior. For example, two seniors qualify for a reduced MSP tax if their income is under $36,000, equal to $30,000 plus two times $3,000.

Effective January 1, 2017 the tax will change to a two rate structure. There will no longer be a charge for children. The monthly MSP tax will be $78 for singles and exactly twice that for a couple, $156. In other words, the $14 a month discount for couples will be gone, or you could say couples will face a $14 per month increase on top of the general 4% increase. MSP tax subsidies will also be adjusted with the cutoff being for incomes under $45,000. The $3,000 adjustments to premium assistance remain, so a senior couple would qualify for some relief with family income under $51,000. A senior couple with income over $51,000 will face a $240 per year increase, a whopping 14.7% over 2016 MSP tax rates. Couples, both of whom are under age 65, will face that 14.7% increase if their family income is over $45,000.

BC is the only province that continues to finance part of its health system with a flat tax, a holdover from the conversion in 1968 from private health insurance to public insurance. Since 2002 the MSP tax has increased every year by twice or more the rate of inflation. Between 2001 and 2015, income tax revenue increased by 56% while MSP revenue increased by 259%. Over the same 14-year period, population increased 15% and the BC Consumer Price Index went up 23%. Clearly the BC Liberals shifted taxes to the relatively flat, regressive MSP tax which is estimated to raise over $2.5 billion in 2016-17, up $124 million from 2015-16 and greater than all natural resource revenues. The 2016 budget estimated that the MSP tax take will increase to $2.78 billion in fiscal year 2018-19.

The government claims that "an additional 335,000 people will see their premiums reduced, including 70,000 single parent families. An additional 45,000 people will no longer pay MSP premiums at all." That could be true, but reductions will automatically be made for high income families going from a family of three or more to just two adults (no longer being charged for children) but lower income families will see no savings unless they complete confusing government forms and apply for premium assistance. Even the government admits that not all those who are eligible are aware that they can apply for the assistance they could receive.

The government announcement didn't mention that people like Premier Clark don't pay the MSP tax because it is paid by her employer (us), as is the case for approximately 40% of all MSP tax payers. With the MSP tax assistance limit at $30,000, another 20% don't pay the tax. In other words, for the 40% who pay the tax, Clark is giving a break to some while increasing the tax by as much as 14.7% for others.

The Minister of Finance says the money for health care has to come from somewhere. He is right, but in every province but BC it comes from taxes based on ability to pay. After the changes that will take effect January 1, 2017, BC will still have the most regressive health tax in Canada.