The Boundaries of Medicare: Tensions in the Dual Role of Ontario's Physician Services Review Committee

In this research, we describe and analyse the Physician Services Committee (PSC) in Ontario, focusing on its role in determining what physician services are publicly funded and what services are de-listed (i.e. no longer eligible for public funding). We explain how the PSC's role in determining the boundaries of Medicare is in tension with its role as a medium for labour relations between the government and the medical profession. We suggest that while the values of privacy, secrecy and a lack of transparency may enhance the PSC's fulfillment of its labour relations mandate, they impede the Committee's successful fulfillment of its health policy mandate. The remainder of this paper is dedicated to a detailed investigation of the PSC's process of determining candidate services for de-listing, and the principles upon which it bases its decisions. Particular attention is paid to the principles of open participation, transparency, accountability, and the degree to which these principles are incorporated into the PSC's decision-making.