October 9, 2009
While media attention may be on US healthcare reform, over the border in Canada, an equally bitter fight is taking place on the future of state and private healthcare.
The outcome will affect medical tourism into, out of and within Canada.
Although this is a highly political fight, it is not being fought by politicians, but in the courts. In British Columbia, private clinics and surgery centres are catering for patients who would normally look to pay privately for faster treatment across the border in the USA. The courts will consider their legality within weeks.
Healthcare in Canada is a government-funded health system where all Canadians get free care. It is not national, but controlled by each province. It was only in 2005 that a Quebec court ruled that private health insurance was legal, and only in that state. This ruling paved the way for private care.
Facing long waits and substandard care, private clinics are proving that Canadians are willing to pay for treatment. Private for-profit clinics are permitted in some provinces but not allowed in others. Under the Canada Health Act, privately run facilities cannot charge citizens for services covered by government insurance. A network of technically illegal private clinics and surgery centres has opened in British Columbia, copying what happened in Quebec. In October, the courts will be asked to decide whether these clinics are legal, illegal, or can operate in a restricted way. More than 70 private health providers in British Columbia schedule simple surgeries and tests with waits as short as a week, compared with the months it takes under the public system.
Brian Day runs a private surgical centre in Vancouver, “You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list.” Opponents say that allowing private care will drive the best medical staff and well-off patients into the private sector; leaving the public sector to slowly crumble. The lawsuit is to determine whether the Canadian Constitution guarantees citizens the right to choose their own care.
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Separately, an investment group backed by Arizona businessman Melvin J. Howard has filed a legal challenge under the North American Free Trade Agreement, demanding that US healthcare companies gain access into Canada. The consortium hopes to build Canada’s largest private health centre in Vancouver, offering orthopedics, cosmetic surgery, general surgery and other services.
Private health insurance is allowed in Canada, but the provincial governments allow it only for services that the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Several provinces have legislation that financially discourages but does not forbid private health insurance in areas covered by the public plans. Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures.
The Canadian government has invested a large amount of money nationwide in a successful effort to reduce wait times, especially for life-threatening conditions such as cardiac disease and tumours, and for procedures such as knee replacements and cataract surgery. Under Canada’s system, most doctors run private practices but are paid uniform rates by a government-funded network. Many Canadians have private or employer-paid insurance that covers things such as dental and eye care, which are not part of the larger plan.
The outcome of the legal case will probably determine the future of private healthcare in Canada. While a few Canadians travel to South America, Cuba and China, most go to the USA. If private treatment is allowed in Canada, then the rationale for most Canadians becoming medical tourists may vanish.
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