Private pay is not the cure for the Canadian health system’s wait-time crisis
by Colleen M. Flood and and Jane Philpott
2020-09-14 from theglobeandmail.com
Colleen M. Flood is the director of the Centre for Health Law, Policy and Ethics and University Research Chair at the University of Ottawa.
Jane Philpott is a former federal health minister and the dean of the Faculty of Health Sciences, Queen’s University.
After 93 days of argument and 101 witnesses, B.C. Supreme Court Justice John Steeves ruled at last on the Cambie case on Thursday, declaring in a whopping 880-page judgment that provincial laws putting limits on a two-tiered health care system do not contravene the Charter of Rights and Freedoms.
The arguments in the case centered on whether allowing doctors to be paid by public medicare and simultaneously bill patients directly, or through private insurers, or all three, is a good idea. Should people be able to pay or use private insurance to jump the queue for hip or knee operations, regardless of their medical urgency? Should doctors be able to “extra-bill” – that is, to bill the public plan as well as charging an additional fee to the patient, who might be allowed to buy private insurance to cover that cost?
Much hinged on whether such practices are likely to make things worse for the majority of Canadians who would be left behind in the public system, and after reviewing a tremendous amount of evidence, Justice Steeves concluded that giving license to doctors to bill on top of billing medicare would not free up resources to improve wait times; instead, he wrote, “there is a strong connection between duplicative private health care and increases in wait times in the public system.”
This decision has the potential for far-reaching effects on the public health care system in British Columbia and beyond. The outcome is so important for the future of medicare it may well be appealed, potentially all the way up to the Supreme Court – whether by the private clinics or the doctors spearheading the challenge, who have much to gain financially from a two-tier system.
Regardless of this positive outcome for public medicare, however, the public system must improve wait times.
Before COVID-19, many Canadians were already concerned about the long waits for some kinds of care. Now, with so many procedures having been cancelled during the first wave of the pandemic, these concerns have become even more acute for some.
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