Regulating Physician Supply: The Evolution of British Columbia’s

Abstract. This paper traces the development of British Columbia’s controversial Bill 41, which empowers that province’s Ministry of Health to restrict the issuance of billing numbers entitling physicians to seek payment from the provincial medical services plan. The bill and its predecessors have been the subjects of two court chal-lenges by the medical profession, and the legal battles continue. The bill has also taken on a role in the evolving interpretation of Canada’s new Charter of Rights and Freedoms. Meanwhile, the policy appears to be dowing the rate of growth in phy-sician supply in the province, but its impact on the real target--medical care costs-is still uncertain. Canadians enjoy virtually universal access to medical care: without fear of its costs. This has not always been so. Canada instituted national health insurance in two stages, first for hospital care in the late 1950s, then for medical care with the passage of the federal Medical Care Act of 1966. By 197 1 all provinces had in place both medical and hospital plans entitling them to federal transfer pay-ments that averaged about 50 percent of costs incurred. Eligibility for this fiscal transfer was incumbent upon the terms and conditions embodied in the provincial plans. In particular, these plans had to satisfy conditions of comprehensiveness, portability, universality, and public administration (LeClair 1975; Taylor 1986). More recently, the Canada Health Act was introduced with the support of all federal parties, reaffirming the Canadian commitment to universality of access under uniform terms and conditions. Under the terms of that act, federal fund