Full financial coverage is commonly termed first-dollar coverage because it involves no user charges at the point of service, including co-payments, insurance deductibles and physician extra-billing. The third dimension of universality involves the extent of health service coverage.
Twelve years later, the federal government passed the Canada Health Act to combat the growing practice of facility user fees and physician extra-billing (Taylor 1987; Begin 1988).
The federal position carried over into the federal-provincial medical care negotiations of the 1960s, a position that was not as restrictive as the Hall Commission's recommendation that the federal government should not at all permit hospital user fees or physician extra-billing to ensure that all Medicare services be free at the point of service (Royal Commission on Health Services 1964: 29).
Indeed, the Liberal government of Saskatchewan under Premier Ross Thatcher would launch the first major experiment with extra-billing. In 1968, in order to deter what it viewed as unnecessary doctor visits, the Saskatchewan government authorized physicians to charge their patients $1.50 per clinic visit and $2.00 for any other visits, including home, emergency and hospital outpatient visits.
However, extra-billing became more prominent in other provinces in the 1970s.
government reduced the growth of its health transfers to the provinces and provincial governments tried to contain health spending, extra-billing allowed doctors to keep up their incomes.
Organized medicine responded by arguing that the vast majority of extra-billing physicians used a sliding scale in which higher-income patients were charged considerably more than middle-income patients, with low-income patients exempted from all direct charges.
To back up the new requirement that access not be impeded in any way by user charges, the CHA stated that any government permitting user fees or extra-billing would be subject to a mandatory dollar-for-dollar federal transfer withdrawal (Heiber and Deber 1987; Tuohy 1988).
While physician extra-billing had been the major flashpoint in the 1980s, facility-based user fees would become a major issue in the 1990s.
The improved relationship exists despite past differences of opinion between the medical association and the NDP, particularly over the issue of extra-billing.
Archer speculated that some doctors encourage more frequent patient visits to make up for the loss of extra-billing privileges, which occurred in 1986.