CUTS THREATEN CANADA PUBLIC HEALTH SYSTEM.

Byline: Associated Press

Locked in a showdown with doctors over health care funding, Canada's largest province is arranging for pregnant women to get medical treatment in the United States.

The dispute, so bitter that many Ontario doctors have threatened to stop taking new patients, is the latest sign that Canada's public health-care system is in crisis.

Hospitals across Canada are closing as provincial governments slash funding. Doctors are emigrating across the U.S. border in quest of higher salaries. And conservative politicians increasingly are raising the once-taboo possibility of revising the health system to allow some privately funded care.

The Canadian system has admirers around the world, who consider it a model of a well-run state health system. But it also has detractors, including the American medical establishment and political conservatives who believe governments invariably make a mess of health care.

The current crisis is most acute in Ontario, where the Conservative government of Premier Mike Harris has been making huge cuts in public spending.

Close to 20,000 obstetricians, other specialists and family doctors have threatened to stop taking new, nonemergency patients as of Nov. 1 if the province doesn't address their grievances. The chief issue is caps on fees; the doctors say government fee schedules no longer cover the cost of their services.

Provincial officials and representatives of the Ontario Medical Association are negotiating on the funding dispute. There has been no indication a settlement is near.

On Thursday, the Ontario Health Ministry confirmed it had sent four pregnant women to Grace Hospital in Detroit because they could not obtain obstetrical care in nearby Windsor.

Dr. Bernard Gonik, chief of obstetrics at Grace, said the hospital agreed to get involved as a humanitarian gesture, not because it needed the business.

``I'm really uncomfortable that this might be perceived as an attempt to take away business from Canadian physicians and Canadian hospitals,'' Gonik said.

Dave Cooke, spokesman on health issues for the leftist opposition New Democratic Party, said the province's action was a ploy to intimidate doctors. Cooke said a delivery in Detroit would cost several thousand dollars, compared with several hundred paid to a Canadian physician.

Ontario officials say obstetricians are paid an average of $261,000 yearly, while the medical association says the amount is one-third less.

Out of that, doctors must pay office expenses, taxes and malpractice insurance, leaving the average obstetrician with $35,900 in take-home pay despite working an average 70-hour week, the association says.

Hospitals across Ontario face closure because of funding cutbacks. Two of the three hospitals in Sudbury, a mining city of 172,000 people, are slated to close, as are three of five hospitals in the Lake Superior city of Thunder Bay.

In Toronto, as many as 15 hospitals face closure over the next several years, and 386 staff members at one of the biggest facilities, Toronto Hospital, are to be laid off next month.