On May 18, in a highly publicized decision, the provincial government of Ontario, Canada, announced that beginning this October, chiropractic services would be "delisted" from the Ontario Health Insurance Plan (OHIP), the province's health care plan. The maneuver, part of the province's new budget plan, terminates more than 30 years of public finding for chiropractic services in Ontario.
The government announced that along with chiropractic care, optometry examinations and physiotherapy would be also delisted from OHIP, in an effort to help balance the province's budget deficit. Ontario Finance Minister Greg Sorbara, who termed chiropractic a "less critical" service in a May press conference, defended the Minister Greg Sorbara, who termed chiropractic a "less critical" service in a May press conference, defended the cuts by saying that they would add up to more than $200 million in savings over the next two years and free up money for other procedures.
"No one in government celebrates the delisting or the withdrawal of any public services," said Sorbara. "These are the most difficult choices we make. Look, we are not punishing anyone. These are less critical services in our view."
Members of the chiropractic profession were quick to criticize the government's decision, and cautioned that the cuts would actually lead to greater health care costs in the long run.
"This is an incredibly shortsighted budget," said Dean Wright, president of the Ontario Chiropractic Association (OCA), which represents more than 2,500 chiropractors in the province. "It's going to be devastating for over 1.2 million Ontarians who seek chiropractic care to help them live their lives. By removing the OHIP coverage, they create another barrier to access to care."
Dr. David Gryfe, a Toronto chiropractor, echoed Wright's sentiments, calling the decision "very shortsighted." "[Chiropractic is] more effective and inexpensive than other treatments, and we thought the government had got[ten] the message," Dr. Gryfe said. "There are countless cases where we can show people are able to avoid more costly care because of chiropractic treatment."
The decision did not sit well with some of the province's politicians, either. Howard Hampton, leader of the Ontario Democratic Party, said that the delisting would affect people with low incomes the most.
"They won't be able to go to the chiropractor [and] they won't be able to get their eyes checked, because they won't be able to afford it," Hampton remarked. "In the end, this will cost the healthcare system more money because they (patients) will wait until they are so sick or so debilitated, and then they will go to the doctor's office, and the doctor's fees are much higher."
Even officials from the Canadian Cancer Society expressed concern that the government had decided to delist "important services" such as chiropractic to help pay for cancer treatments.
"While the Society supports reducing wait times for cancer care, we are troubled by the decision to delist important services in other areas to pay for cancer care," the CCS said in a statement on its Web site. "Services such as chiropractic care, physiotherapy and optometry testing are important to many people in Ontario, including cancer patients and their families."
Withdrawal of Coverage Hurts Practitioners and Patients
Over the years, a variety of services have been delisted or restricted from OHIP, including electrolysis, circumcision, sex-change operations, audiological aids for children, some fertility treatments, and wart removal. In 1998, the frequency of eye examinations was reduced to once every two years. In 1999, yearly coverage for chiropractic services was reduced from $220 to its current level of $150, and the limit for annual chiropractic visits was cut from 22 to 15.
Previous evidence has shown that coverage of chiropractic care can reduce overall health care costs; in fact, a 1993 study funded by the Ontario Ministry of Health found that enhanced OHIP coverage of chiropractic treatment could save Canada's health care system an estimated $380 million a year in direct costs, and an additional $1.2 billion per year in indirect costs attributed to short- and long-term disability.
In this year's round of cuts, however, the government not only overlooked the existing research and chose to delist chiropractic; it also made chiropractic the only service of the three to be delisted without any exemptions. While optometric services will also be delisted this fall, senior citizens and Ontario residents under 20 years of age will still receive free routine eye examinations, as will people with glaucoma, cataracts and diabetes. The cuts to physiotherapy won't begin until April 2005, and even then, they won't affect senior citizens who are on the Ontario Disability Support Program, or those who are eligible to receive physiotherapy through home care and long-term care facilities.
According to an article in the London Free Press, a typical office visit to a chiropractor currently costs a person about $20, after adjusting for OHIP coverage. Once the delisting takes effect, the price will jump to roughly $30. While some residents have extended coverage through their employers, most depend on OHIP to help provide payment for chiropractic services. For people on fixed incomes or tight budgets, that extra cost could result in delays in seeing their chiropractor for routine care, or cause some residents to stop seeing a DC altogether.
"Not everybody has private coverage," explained Dr. Lisa Rino, a Windsor chiropractor and president of the Essex Chiropractic Society. She added that cutting funding for chiropractic services would result in more people making visits to hospitals and emergency rooms, and could end up costing the health care system "far more than it would save."
"There's going to be more needless back surgery, more reliance on medication with all the harmful side-effects, more lost time from work, (and) more disability than ever, if these changes go through," observed Dr. Diane Bell, a London, Ontario chiropractor. Based on the severity of the cuts, she said, some people with low incomes could stop going to their chiropractors altogether.
"A lot of patients don't have extended health care, particularly the poor and the retired," added Dr. Maureen Henderson, who has practices in Toronto and Brampton. "They won't be able to access chiropractic services ... It's going to cost the government a lot more. Probably in the millions" to provide care. She also expressed concern over the effect delisting might have on the ability of new chiropractors to operate a successful business. "It's certainly going to impact a new graduate who might not be able to make his overhead," said Dr. Henderson, who has practiced chiropractic for 29 years. "A lot of us have patients who will come despite the fee, but that's not the majority. For people starting out, it's going to be very difficult."
OCA Takes Action
In a press release following the government's announcement, the OCA charged Ontario's leaders with failing to consult with members of the chiropractic profession, or the general public, before deciding to delist chiropractic services. According to the release, the government "held absolutely no consultation with either the chiropractic profession or the people" of Ontario, and emphasized, "The people of the province were never given the opportunity to express their views on public funding for chiropractic."
"It doesn't add up," said Dr. Wright, who also offered to work with government leaders to find a way to keep chiropractic in OHIP:
"We are urging the government in the strongest possible terms to confirm its commitment to universality and equal access in health care, by continuing to provide OHIP support for chiropractic care ... The OCA is prepared to work with the government to find a solution to this issue, and to avoid causing millions of patients to live with pain, to avoid damaging the provincial economy, and to avoid heaping additional costs onto an already overburdened health care system."
The OCA has also set up an "OHIP Funding" section on its Web site, where users can read the latest updates, sign a petition against the delisting, and e-mail their concerns to the Ontario government. The OHIP Funding section is available at www.chiropractic.on.ca/OHIP Funding.html.
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