In June 2005, the Supreme Court of Canada rendered judgment in favour of Dr. Jacques Chaoulli (pictured), who argued that the Quebec single-payer healthcare system violates our constitutional rights to life, security, and liberty of a person. | Photo Robert Mailloux, Archives La Presse
A Consequential Ruling (Chaoulli v. Quebec)
On June 9, 2005, the Supreme Court of Canada overturned provincial legislation prohibiting Quebec residents from buying private health insurance for health care services covered by the public health care plan. Quebec’s law is similar to legislation in other provinces that protects the public system from an expanding private sector. As such, this ruling could become “the Magna Carta for two-tier” Medicare through future legal and constitutional interpretations.
Indeed, on July 30, 2005, Alberta’s Premier, Ralph Klein, stated that
"the Supreme Court of Canada decision has forever changed our health-care landscape."
He then argued that Albertans should rely less on the publicly funded healthcare system, and gravitate to an expanded parallel system that can "end your pain and suffering, but to do so at your own cost." The following year, the government planned to introduce a new Health Care Assurance Act, which would allow patients to pay for surgeries at private clinics and eliminate public coverage of prescription drugs and continuing care.
Earlier this year, the conservative premiers of Ontario, New Brunswick, Nova Scotia, and Prince Edward Island met in Moncton to signal their openness to private sector delivery as a panacea for staffing shortages and inordinate waiting times at Canadian hospitals. However, readers will soon come to learn that additional private-sector capacity will have antithetical effects in the healthcare industry, and contribute to rising costs, as well as social inequity.
The Concerning Impact
Academic experts assert that increasing access to private care does not reduce waiting lists in the public system. For example, researchers - including Claudia Sanmartin, Samuel E.D. Shortt, Morris L. Barer, Sam Sheps, Steven Lewis, and Paul W. McDonald - point out that a prospering private option in the United Kingdom has not alleviated public sector waiting periods, despite roughly 11 percent of the population relying on the former. Further, Colleen M. Flood and Terrence Sullivan discussed the private sector's operation of cataract surgeries in Manitoba, by the time it was rejected in 1996. A study revealed that waiting times were over twice as long for publicly financed services by ophthalmologists who practiced in both sectors (23 weeks), than their counterparts who worked solely in the public sector (10 weeks).
Meanwhile, healthcare professionals note that major hospitals will be forced to significantly increase their spending on nurses from private agencies. Sunnybrook Hospital, alone, has already overseen annual expenditures climbing from $4.5 million in 2018-2019 to $8.2 million in 2021-2022. Additionally, according to Dr. Dick Zoutman, the former chief of staff of the Scarborough Health Network, these private clinics will continue to siphon off more workers from public hospitals and urgent care centres, in turn, exacerbating staffing shortages. Indeed, Dr. Michael Warner, an intensive care physician at Toronto’s Michael Garron Hospital, questioned “why is it that my hospital, for example, has at least three private agencies providing nurses every day to our hospital at a premium that’s costing the hospital more than they’ll have to pay our nurses?” In actuality,
“it’s costing them sometimes double or triple the amount to pay these private companies.”
The trail of evidence does not stop here. In a similar line of thinking, Timothy Caulfield argues that expanding the private option may bolster inefficiencies and costs in the operation of the healthcare industry. Surely, dealing with premiums, co-payments, surtaxes, and offloaded programs will “increase citizens’ and businesses’ costs and erode equity.” As an illustration, a private service called Home COVID-19 Private (HCP) Diagnostics charged patients up to $400 per COVID-19 test during the global pandemic, while low-income and racialized Ontarians bore the brunt of cases in every single wave. Further, for-profit long-term care homes experienced 78 percent more deaths and twice as many COVID-19 cases as non-profit homes.
Alternative Policy Solutions
The Federal Commission on the Future of Health Care in Canada, led by Roy J. Romanow, declared that there is “no evidence” to suggest that greater privatization can “deliver better or cheaper, or improve access.” For this reason, this section discusses policy measures that eliminate obstacles to effective healthcare delivery.
First, provinces and territories should advance recruitment and retention measures in the public system that include fast-tracked registrations for internationally trained workers, loan forgiveness and signing bonuses for medical graduates, better working conditions, and partnerships with medical unions.
Secondly, transformational changes need to be made to address the primary care crisis that has left 6 million Canadians without a family doctor. British Columbia has already been pivotal on this front, and has created a new payment model to fairly compensate physicians. Instead of being paid $30 to $40 a visit - despite the complexity of a patient’s condition - doctors will now be paid based on their time spent with patients, the number of daily visitations, the number of patients connected to their practice, the gravity of each patient’s illness, and office overhead costs. This seismic change should be replicated in other regions, in an effort to address the costs of running clinics and setbacks in the delivery of longitudinal care.
Thirdly, the country needs to scale up their programs and services options for seniors and adults with disabilities, similar to the approach being taken by the County of Renfrew, Ottawa Valley, and Algonquin Provincial Park. In these sparsely populated areas, residents can call a toll-free number and then meet a physician in an office or a community paramedic can be dispatched to their home to gather their medical data, and then liaise with the family doctor — along with a team of nurses, practitioners, pharmacists, occupational therapists, etc.
As a believer in the economic and social advantages of a publicly funded healthcare system, I hope that steps will be taken in Canada to preserve and protect it. Academic commentators, health policy experts, and medical professionals laud the integrity and viability of our universal healthcare model. To be sure, the "equality of access” principle at the heart of our Medicare, certainly depends upon it.
Written By: Emmy Eguly, Policy Strategist - Engage