Fall 2005

H e a l t h   P o l i c y
Ruling on private insurance has far-reaching impact 

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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.



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