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Canada’s publicly funded health system under threat

by Rupinder Brar

Three things you should know about the Charter challenge

Closing arguments ended February 28, 2020 in the Supreme Court of British Columbia for a landmark trial challenging the fundamental principles of Canada’s public health care system.

In this constitutional challenge brought by Cambie Surgeries Corporation, the B.C. government is calling on the court to uphold specific features of B.C.’s law that protect equitable access to care for all. These include a ban on extra billing that prevents doctors from charging patients more than what the government already pays them and a ban on private insurance that duplicates what is already covered by BC’s Medical Services Plan (MSP).

But there’s an awful lot of confusion about what’s at stake.  Here’s what you need to know to cut through the spin.

  1. Private payment for healthcare is already allowed in B.C.

Private payment for insured services is already allowed in B.C., so long as doctors are not enrolled in the public plan (MSP) and they don’t provide care in public facilities, like hospitals. By simply unenrolling from the public plan, doctors are free to work and bill patients privately as much as the market will bear. What doctors can’t do is bill privately if they are enrolled in the public plan.

  1. Multi-payer health systems with private insurance don’t reduce wait times

Wait times are an issue in Canada for some services in some jurisdictions, as they are in every health care system in the developed world. In the more than three years since this trial began, the plaintiffs have failed to demonstrate that a multi-payer system with private duplicate insurance would reduce wait times.

In fact, evidence from other countries shows that allowing private insurers to pay for what’s already covered by public plans increases wait times for those who cannot afford private insurance.

This is well documented in the Australian experience.

Starting almost twenty years ago, the Australian government incentivized its citizens to purchase private duplicative insurance in a move to infuse more cash into the system and take pressure off the government. They did this through $9 billion in annual tax subsidies to the private insurance industry.  Despite this subsidy, Australians are increasingly dissatisfied with private health insurance, as premiums are increasing faster than wages.

After almost twenty years, Australia’s experiment with private insurance shows that those who purchase it have clearly benefitted with quicker access to services, but overall wait times in the public system have increased.

The reason for longer waits is quite simple: as more patients use the private pay system they necessarily pull human resources — was doctors, nurses, operating room staff — out of the public system, attracted by the higher earning potential.

  1. Innovation reduces wait times, not private billing

It’s a common mantra to claim that allowing enrolled doctors to bill patients privately would resolve the issue of wait times for all patients. In fact, it is through public innovations where real progress can be made. Canada has seen this first-hand but we don’t always do a good job of spreading and scaling our successes.

For example, Rapid Access to Consultative Expertise (RACE) is a phone based system available in much of B.C. that gives family physicians access to a rapid-access telephone consultation service with specialists. The pilot project found 80 per cent of calls were returned within 10 minutes, most consults were less than 15 minutes long, there were 50 per cent fewer referrals for face-to-face consults and a reduction of emergency department visits by 24 per cent.

It comes down to equitable access

Do Canadians want equitable access to healthcare for all, or do they want preferential access for those who can pay while leaving those who can’t pay to wait even longer?  This is ultimately what the trial is about.

The plaintiffs are challenging the central organizing principle of our public health care system – that care should be provided on medical need and not the ability to pay. Should they succeed in their challenge, we will end up with a system that benefits the minority who can afford private payment but harms the majority of Canadians who can’t.

Photo courtesy of Pixabay

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