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Canadian health care system wary of incursion of for-profit enterprise

The furore generated by the passage into law of Alberta’s Bill 11 in September generated headlines throughout Canada, with critics claiming that it would open the door to a two-tier health care system in which well-heeled patients could pay for faster service. In this issue of the Canadian Medical Association Journal, Dr. Sam Shortt notes that attention paid to the bill has overlooked the “more immediate concern that Bill 11 will allow international trade tribunals to intrude into our domestic health policy” due to international trade agreements. Shortt states that while it may seem that the health care system would be protected from the free-market forces unleashed in the larger economy, there is no clear consensus that this interpretation is correct. “The legislation assumes significance as an early warning that, without due vigilance, seemingly minor structural changes may have far-reaching consequences for a national health care system,” concludes Shortt.

In a similar vein, Colleen Flood and Tom Archibald address the question of whether private health care is illegal in Canada by surveying health insurance legislation in all 10 provinces. Their survey revealed multiple layers of regulation that seem designed to prevent the private sector from subsidizing the private sector, as opposed to rendering privately funded practice illegal. Private insurance for medically necessary hospital and physician services is illegal in only 6 of the 10 provinces. Nonetheless, a significant private sector has not emerged in any of the 4 provinces that do permit private insurance coverage. The authors conclude that the absence of a significant private sector is probably best explained by the prohibition on having public plans subsidize private practice, measures that prevent physicians from topping up their public sector incomes with private fees.

The illegality of private health care in Canada
— C.M Flood, T. Archibald
Contact: Dr. Colleen Flood, Assistant Professor, Faculty of Law, University of Toronto; tel 416 978-4929

Alberta’s Bill 11: Will trade tribunals set domestic health policy?
— S.E.D. Shortt
Contact: Dr. Sam Shortt, Queen’s Health Policy Research Unit, Queen’s University, Kingston; tel 613 533-6387

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