What A Canadian Court Case Might Mean For the U.S. Health System

Thursday, June 23, 2016 | Larry Sobal

 

As our own presidential election looms closer, inevitably one of the topics to be compared and contrasted between candidates will be health care. I'll save the Clinton versus Trump health care agendas for a later blog.

What is more interesting at this moment is the pending legal trial that may have significant implications on the Canadian health care system. It's a legal challenge most Americans are probably not aware is about to happen, but it comes at a time when a single-payer health system may become hotly debated in the U.S. It is worth drawing attention to since it is likely that we will look to the Canadian health system for examples and answers to its merits.

As most Americans are aware, Canada has operated under a single health care payer model since the inception of the Canadian Health Act in 1984. Canadian patients have few options when it comes to health care services, as care that is considered medically-required remains largely monopolized by the public sector in each province; however, unbeknownst to most Americans, there is a growing degree of private health insurance in Canada.

In June 2005, the Supreme Court of Canada ruled, as part of its Chaoulli decision, that when the government is unable to provide access to required care within a reasonable timeframe for citizens of Quebec, the prohibition on taking out private health insurance constitutes a violation of patients' rights under Quebec's Charter of Human Rights and Freedoms.

In principle, the legislative changes that followed the Chaoulli decision authorized Quebecers to purchase duplicate private insurance for a limited number of medical and surgical treatments, such as hip and knee replacements and cataract removals. The law also authorized public hospitals to sign partnership agreements with private surgery clinics for the transfer of a certain volume of surgeries and treatments. Three agreements of this type signed in recent years led to significantly improved access in the public hospitals concerned.

Since then, other Canadian provinces adopted health care practices openly in violation of the Canadian Health Act such as extra-billing in Ontario and private MRIs in Saskatchewan. This may be because the most commonly-cited criticism about health care in Canada relates to access and wait times. In 2013, Canadians, on average, faced a four-and-a-half month wait for medically-necessary treatment after referral by a general practitioner. This wait time is almost twice as long as it was in 1993, when national wait times were first measured.

Unbeknownst to most Americans, there is a growing degree of private health insurance in Canada.

And now, a new legal challenge is emerging in Canada; this time, in British Columbia. The difficulty of accessing health care has prompted a group of clinics and patients to go before the courts and contest the legitimacy of the government's monopoly over the provision and financing of health care—and to extend the options provided for Quebec to the rest of the country. The plaintiffs not only want it to be legal for patients to purchase private insurance covering medically-required care; they also want the prohibitions against mixed medical practice and the determination of doctors' fees to be lifted.

What I found interesting in my research is that there is more privatization of health care in Canada than I would have imaged. Dr. Colleen M. Flood, a professor in the Faculty of Law, the School of Public Policy & Governance, and the Institute of Health Policy Management & Evaluation University of Toronto, writes that “What distinguishes Canada’s health system from others is not how little private finance we have but how much private finance we already endure. Canadians have their health needs covered by the public system only 70 per cent of the time, much less than the U.K. (84 per cent) or Norway (85 per cent) or even France (77 per cent). Indeed, Canadians actually hold more private health insurance than Americans do. How is this possible? Our health system fails to offer universal (public) coverage for prescription drugs, unlike the coverage provided in nearly every other developed country in the world. Canada also has inadequate coverage for home care and long term care, which are more comprehensively covered in many other health systems, such as Japan, Germany, Belgium and Sweden. Unfortunately, our health system is more like the U.S. system than most of us know.”

I will begin paying closer attention to what is happening with our neighbors to the north and this court case, in particular. What is decided may offer some insights into what the U.S. should—or shouldn't do—with our own health system.

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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