The court case to legalize private healthcare in Canada is coming to a close this week, and it could potentially change the course of Canadian healthcare forever. For the past 10 years, Vancouver doctor Brian Day has been leading a legal crusade to argue that private health care should be able to work together with Canada's publicly funded Medicare system. So, as we conclude the closing arguments in Day's case, let's take a look at why Canada prohibits private health care in the first place. The Canadian healthcare system is unique even compared to other countries with socialized healthcare.
For example, Australia guarantees health coverage for all citizens, but you can still pay out-of-pocket for a boutique appendectomy if you choose. Up until World War II, virtually all Canadian health care was provided through the public sphere. In the 1970s, however, Canadians began to experience user fees and co-pays that threatened the universality of Canadian healthcare. In response, Emmett Hall wrote a historic report condemning these fees for undermining the health system.
He argued that Canadians had long agreed that health services should never be “factory-bought and paid for at the checkout.” This report eventually led to the Canadian Health Act, which explicitly prohibited “additional billing” and prescribed reductions in funding to any province that tolerated it. The Act was passed with almost unanimous support from the House of Commons. Technically speaking, there is no general federal ban on private health care in Canada. Any doctor can opt for private companies as long as they don't work for the public system.
However, a doctor cannot simultaneously bill the province and charge patients directly; they have to choose one or the other. In addition, some provinces have tightened conditions even further by preventing private doctors from charging more than what is prescribed under the provincial health plan. Despite these restrictions, a very small private sector dedicated to necessary health care still exists in Canada. Estimates suggest that approximately 1% of critical health care takes place outside of the public system. Brian Day's Cambie Surgery Center in Vancouver is one of the few examples of private sector doctors in Canada.
The Center is promoted as “the only independent private hospital of its kind in Canada” but it can only serve a small demographic of patients who are exempt from provincial regulations. Supporters of private healthcare argue that by allowing patients to pay for their own health care, space in the public system is freed up for everyone else. Private healthcare in Europe has not definitively eliminated waiting times or other inconveniences of rationed public healthcare, but it has proven capable of coexisting with a public system without precipitating its collapse. Interestingly enough, some provinces crack down on private hospital care while leaving dental care or pharmacy almost entirely in the hands of for-profit actors. A decision from 1980 stated that “waiting lists to access health services have caused deaths, have increased the time patients have to suffer and have reduced the ability of patients to enjoy a real quality of life.”Recently, federal and provincial government officials have been trying to determine if a new private health clinic in Calgary is breaking the law by offering doctor-provided concierge drugs in exchange for an annual membership fee. Cleveland Clinic Canada's assisted medicine program offers personalized access to a dedicated doctor and health care team 24/7.This article has provided an overview of why Canada prohibits private health care and how it still manages to exist despite restrictions.
It's important to note that this court case could potentially change Canadian healthcare forever and it will be interesting to see what happens next.
