the alberta medical plan

The Alberta Medical PlanAuthor(s): P. B. ROSESource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 56, No.2 (FEBRUARY 1965), pp. 74-76Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41983671 .

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The Alberta Medical Plan1

P. B. ROSE,2 M.D.

HTHE statement "medical services insurance should be available to all regardless

of age, state of health, or financial status" is not new in Canadian medicine. This statement, or one very much like it, was first propounded by the Canadian Medical Association at its convention in 1942, it was re-worded in 1949, and the statement quoted dates from 1960.

In 1935, a group of doctors in British Columbia incorporated the Medical Ser- vices Association (B.C.), one of the first prepaid medical service plans in Canada. In Alberta, a committee to study prepaid care met during 1938-39 in Edmonton under the chairmanship of Dr. Roy Ander- son. Similar developments took place in Ontario at about the same time. The belief of the medical profession in Alberta in the principle of medical services insurance as a means of making medical care available to all gave birth to Medical Services (Alberta) Incorporated in 1948. In 1958, on its tenth birthday, M.S.I. commenced to sell individual contracts, on a community rated premium basis, to any- one in the province regardless of age or state of health, as a further extension of this belief.

Pensioners' Medical Service Since 1946 the Alberta Government has

been a partner in an agreement with the College of Physicians and Surgeons of Alberta that has, under most amicable terms, provided comprehensive medical services to citizens receiving provincial welfare payments. Now, 65,000 people - children, widows, aged, and the blind - are receiving excellent professional care and do not seem to be particularly concerned that some yardstick was necessary to qualify for such benefits.

Over the years the profession has met periodically with the government and

Presented at the 55th annual meeting of the Canadian Public Health Association held in Moncton, N.B., June 1-4, 1964. -Director, Medical Services Division, Department of Health, Edmonton, Alberta.

worked out the contributions to be made to their fund by the government for dis- bursement to their members for services rendered.

In briefs presented independently to the Royal Commission on Health Services, early in 1962, both government and medical profession recognized three groups of people.

1. Those who can afford to pay for medical services, or medical services insurance, and who should be prepared to accept the responsibility.

2. Those who qualify for social assistance who should have their medical insurance paid for by the Provincial Government with subsidy by the medical profession.

3. Those who fall between these two groups, who should have help from the Government in paying the cost of their medical care insurance.

The profession had been studying the whole problem, and before a specific program had been evolved, an informal meeting was held at the request of Premier Manning in October 1962. This meeting was attended by the Premier, the Minister of Health, the Provincial Treasurer, and representatives of the medical profession. The Premier outlined his thoughts in respect to government participation in health services in general, and the medical profession expressed theirs. It appeared that there was a general area of agreement.

The medical profession was asked to undertake certain studies, to enable them to make recommendations to government, in respect to the type of plan which could be evolved which would be acceptable to both, and further the aim of making medical services insurance available to all Albertans.

Principles The government felt that there were

four fundamental principles that must be present in any program that was developed, and these were:

74



February 1965 ALBERTA MEDICAL PLAN 75

1. The program must be entirely voluntary and free from any government regi- mentation or interference with individual rights and responsibilities.

2. It must preserve inviolate the doctor- patient relationship that is, in our opinion, necessary to a high standard of medical care.

3. It should employ the insurance principle as the means of equalizing the cost of medical services.

4. It must maintain the responsibility of the individual in providing for his medical requirements, with the state assuming its responsibility to assist to the extent necessary to bring medical services within the financial reach of all the people. Treatment Services Act

Alberta, in 1955, developed an Act which provided authority for the government to enter into agreements for the provision of medical services.

In the 1963 session of the Legislature, this Act, the Treatment Services Act, was amended and broadened to permit the Minister of Health, with the approval of the Lieutenant Governor in Council, to enter into agreements with Medical Ser- vices (Alberta) Incorporated or any insurance corporation whose basic program of medical services insurance has been approved by the Government and the Col- lege of Physicians and Surgeons of Alberta, to provide medical services insurance, with comprehensive benefits, to those eligible residents who desire it, and who need assistance to purchase the contract; it provides for a specified dollar subsidy to be made to those individuals who need assistance. It also empowers the Minister, after consultation with the College, to make such regulations as he considers necessary to carry out the program.

Other amendments to the Act provide for extended health benefits, and for a program of financial assistance in cases where because of sickness or disability a resident is faced with expenses that could not reasonably be foreseen.

Provision is also made for the establish- ment of an advisory committee to consider at least annually the operation of this Plan. The make-up of this advisory committee is presently under consideration and labour organizations will undoubtedly be represented.

In an atmosphere of mutual co-operation, representatives of the government, the medical profession, Medical Services (Alberta) Incorporated, and the Canadian Health Insurance Association embarked on a long series of meetings which culminated in the Alberta Medical Plan as announced on June 25, 1963.

Alberta Medical Plan The Plan is a comprehensive one pro-

viding one level of medical benefits which are income rated in a basic standard contract. Services of a physician in and out of hospital, laboratory services and diagnostic aids both in and out of hospital are provided. After a waiting period, maternity benefits, annual check-ups, and psychiatric treatment are provided.

The comprehensive contract is guaran- teed renewable for the life-time of the participant, and provides for a waiver of premium, for a period of up to six months in the event of sickness or disability. Subsidy

The government subsidy will be provided to Alberta residents, who have had no taxable income for the preceding year, or whose taxable income was not over $500 in the preceding year. This subsidy is a specific dollar amount, and will be paid on behalf of a contract holder, to the insurance carrier of his choice.

The amount for those with no taxable income in the previous year is:

Single individual - $18 per year Married couple - $42 per year Family of three or more - $72 per year

For those with taxable income up to $500 the subsidy is half of these amounts.

The best available figures suggest that there are about 425,000 people eligible to be covered under the two groups of subsidized contracts, and when all are enrolled the cost to the provincial government will be about 6/2 to 7 million dollars.

Regulations The regulations provide for the setting

up of various bodies to operate the Plan, as well as outlining the benefits offered, those eligible, exclusions, etc.

The Co-ordinating Directorate composed of one representative each, from Govern- ment, who acts as Chairman, medical profession, M.S.I. and commercial car-



76 CANADIAN JOURNAL OF PUBLIC HEALTH Vol. 56

riers, will administer the Plan, and will advise Government regarding policy, regulations, pooling, maximum premiums and approval or withdrawal of approval of carriers should it be necessary.

Alberta Medical Carriers Incorporated , is a non-profit corporation which will operate pooling arrangements on the terms and conditions set forth in the articles and regulations of the corporation. Every approved carrier has to become and remain a member of this corporation, which may under certain circumstances exempt an approved carrier from participation in the pooling arrangements. It will be made up of representatives of M.S.I, and the Com- mercial Carriers with a Chairman agree- able to the carriers and the profession.

An Assessment Committee composed of one representative each from M.S.I., and C.H.I.A. and three from the medical profession has also been set up. They will mediate over problems arising between physicians and carriers.

Participants At the present time, as well as Medical

Services (Alberta) Incorporated, there are some 45 private insurance companies that are participating in the Alberta Medical Plan. All except one group of eight companies are members of the Canadian Health Insurance Association.

All these companies' policies have been specifically written for, or modified so that they offer the comprehensive coverage required for participation in the Alberta Medical Plan. This is a sincere expression of their desire not only to participate in the Plan, but to insure its success. Enrolment

Total enrolment at March 15, 1964, was 703,568 people. Of these, 157,000 were covered by subsidized contracts, Medical Services (Alberta) Incorporated having 95,680 people and the Canadian Health Insurance Association 61,328 people.

The budgeted amount for the first six months of operation, October 1, 1963 to March 31, 1964, was $850 million. At the end of February 1964 a total of $718,494.71 had been expended and it is estimated that the total cost will be $1.1 million.

A survey of the province in December

1963 indicated that about 1,100,000 or 80% of citizens had some form of medical coverage or medical insurance coverage. Included were the 65,000 people covered under the Pensioners' Medical Fund, and a small and varying number receiving social assistance.

A similar survey in 1961 showed that about 67% of Alberta citizens had some form of medical coverage or medical insurance coverage.

Summary The Alberta Medical Plan represents the

first time that principles of selective assistance, multiple carrier involvement, and voluntary participation for the patient and doctor have been embodied in any plan by any government. We believe that these principles are valid, and that the people of Alberta are showing their agreement through growing participation in the Plan.

Sommaire En 1955, V Alberta établit une loi qui

garantissait l'autorité nécessaire au gou- vernement pour passer des contrats afin ďassurer des services médicaux.

Dans une atmosphère de collaboration mutuelle , les représentants du gouverne- ment , de la profession médicale , des "M.S. ( Alberta ) I." et de l'association canadienne ď assurance-santé commencèrent une lon- gue série de réunions qui se terminèrent par la création du plan médical de l'Alberta , tel qu'annoncé le 25 juin 1963.

Ce plan qui est détaillé et complet pour- voit des services médicaux à un certain palier, basés sur le revenu dans un contrat- type. Les services d'un médecin à l'hôpital et hors de l'hôpital, les examens de labora- toire et les procédés de diagnostic à l'hôpi- tal et hors de l'hôpital sont assurés. Après une période d'attente, la maternité, les examens médicaux annuels et les traite- ments psychiatriques sont inclus. Le contrat au complet peut être renouvelé pour la vie entière de l'assuré et prévoit une exemption de la prime pour une période de six mois à l'occasion de maladie ou d'incapacité.

C'est la première fois qu'un plan, tel que le plan médical de l'Alberta, incorpore les principes de l'assistance sélective, impli- quant de multiples avantages ainsi que la participation volontaire du patient et du médecin.



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