e a l t h P o l i c y
private insurance has far-reaching impact
What is ultimately at
issue in the case is whether the Canadian public should have wider
access to privately-funded preferential medical care.
by Roger Chafe
There was a great deal of discussion
over the summer about the Supreme Court’s ruling regarding private
medical insurance. In June, the Court ruled that a Quebec law
banning the sale of private medical insurance for medical services
already covered by the public health care system violates Quebec’s
Charter of Human Rights and Freedom.
While the Court’s ruling relates only to
Quebec, it is likely to have an impact right across the country. It is
worthwhile considering what the likely impact will be on our province.
What is ultimately at issue in the case is
whether the Canadian public should have wider access to privately-funded
preferential medical care.
Canada is distinct from other
industrialized countries to the extent that it does not have a parallel
private system for the services covered by the public system. For
example, care provided in hospitals and by family doctors is almost
exclusively publicly funded.
Private medical care is not illegal in
Canada. But the provinces do employ a number of disincentives to
discourage a parallel private system. The disincentives used vary from
province to province. One of the main disincentives used is to deny
physicians the opportunity to work under the public insurance plan and
to also have eligible patients paying privately. In other words,
physicians are forced to choose between whether they will have only
patients who pay for services themselves or patients who are covered
under public provincial plans.
Some provinces deny any public subsidy to
patients of physicians who opt out of their Medicare program. Some
provinces do not allow physicians who opt out of the public system to
bill patients more than what they would under the public system. Others
ban the sale of private insurance for services covered by the public
plan. It is this last legal disincentive which is the subject of the
recent Supreme Court case.
In a strictly legal sense, the Court’s
allowing for the sale of private medical insurance will have no effect
in Newfoundland as the sale of private medical insurance for medical
services covered by the public health care system is not banned here.
The true impact of the ruling, however,
goes beyond what the court specifically grants in this case. Rather, the
real impact in this province relates to the tone the ruling sets in the
debate about whether to have a two-tier health care system. The ruling
gives a good deal of insight into how the Supreme Court is likely to
rule in future cases involving limitations on privately funded health
care, wait times, and the rights of patients and providers to move
outside of the public system.
In this case, the Supreme Court of Canada
made a poor decision, unsupported by most of the relevant evidence.
Still, the ruling is a victory for those across the country who advocate
increased private health care and who support some Canadians having
access to a privileged, two-tier health care system. In the end, it is
still up to the government, health care providers, and the public of
this province to determine where we go from here.
Roger Chafe is a doctoral candidate in
the Community Health Program of Memorial University of Newfoundland.