Dr. Danyaal Raza is a family physician in Toronto, assistant professor at the University of Toronto, and the chairperson of Canadian Doctors for Medicare.
Right now, in British Columbia, a historic legal challenge to the fundamental principles of Canada’s health system is under way at the province’s highest court.
If that sounds significant, it is – even if the details themselves seem a bit rote and complicated.
The corporate plaintiff in the case – Cambie Surgeries Corporation – is looking to overturn key provisions in B.C.’s Medicare Protection Act. That law prohibits extra billing, meaning doctors enrolled in medicare can’t charge patients extra on top of what B.C.’s Medical Services Plan (MSP) pays them. It also bans private duplicative insurance that would cover the same services as the public plan, as well as dual practice, thus preventing doctors from being paid from both the public purse and privately. These three provisions protect equitable access for patients, ensuring that care is provided first to those who need it most, rather than to those who can pay for faster access.
These provisions also restrict corporate profits. And so for years, as Cambie Surgeries Corporation has charged patients additional fees, it has thus been persistently violating the B.C. Medicare Protection Act. In response, and for more than two decades, the province has been amending, strengthening and expanding the enforcement provisions of the law in an effort to stop Cambie from breaking the law.
Cambie Surgeries Corporation has taken the case to the Supreme Court of British Columbia, fighting for the right to charge fees to patients who are willing to do so to be at the front of the line. And in taking on the Medicare Protection Act in the pursuit of higher incomes for physicians who work in private for-profit clinics, Cambie Surgeries is challenging a core principle of Canada’s health-care system, as enshrined in the Canada Health Act: that care should be provided based on need, not on ability to pay.
To be clear, the trial itself is not about the mere existence of private clinics. It is not unlawful to operate a private, for-profit, investor-owned health care facility. So long as the doctors who work there are not enrolled in B.C.’s MSP, they can charge patients whatever the market will bear. What enrolled doctors can’t do is charge patients for medically necessary hospital and physician care.
Cambie is not the first to call for expanding private payment in the health-care sector. But whenever health care systems in other countries have moved toward such an approach, the result has been an increase in wait times for patients who can’t afford to pay privately.
Australia introduced private duplicative health insurance in an attempt to reduce wait times by generating new revenue without raising taxes. Yet, wait times grew even longer for those who couldn’t afford to buy private insurance. A very recent private-pay MRI scheme in Saskatchewan yielded similar results: wait-lists doubled.
There is, however, another way.
Consider ReBalanceMD in Victoria, an interdisciplinary orthopaedic-care clinic. Using a triage system called First Available Appropriate Specialist Triage, the clinic dramatically reduced wait times by streamlining the patient experience.
Similarly, a pilot project in Ontario that has since scaled province-wide has improved access for patients with chronic back pain. By providing co-ordinated consultations and team-based care, it has reduced wait times for specialists from 18 months to as little as two weeks.
An e-consultation in eastern Ontario that is built around virtual access to specialists has reduced family-doctor waits for specialists’ advice to less than two days, all while saving money and avoiding unnecessary specialist consultations.
These are but a few of the many public innovations that have successfully reduced wait times without expecting patients to “choose” private payment.
But worst of all is the wide-ranging potential impact of the case for all Canadians. If the court rules in favour of the corporate plaintiffs and declares the B.C. Medicare Protection Act unconstitutional, then the entire Canada Health Act could be rendered unenforceable. Evidence in the trial from U.S. experts makes clear that this could unravel medicare across Canada and open the door to an inequitable and inaccessible American-style health care system.
Our health care system is imperfect, but reforms proposed by the plaintiffs would benefit only those who could afford to pay for the privilege of faster access, at the expense of millions more who would be forced to wait longer for our publicly-funded system.
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