Ask a random Canadian if our health care system looks more like that of the United States or the United Kingdom. Chances are, most will respond that our system is nothing like that of the US \u2014 which is largely paid for privately \u2014 and every bit like the UK\u2019s, which is publicly funded.<\/p>\n
The reality is more of a cold shower.<\/p>\n
When we look at data<\/a> from the OECD comparing the health systems of the wealthy countries of the world, we see that Canada is well ahead of most peer countries in terms of private financing, with a whopping 30 percent of our health expenditures paid for through private health insurance or out-of-pocket spending. This is 50 percent higher than in the UK, where private health spending is at 20 percent, and three times as much as in France, where it\u2019s only 10 percent.<\/p>\n A case in the British Columbia Supreme Court has some worried that we might see even greater development of the private-pay health care market across Canada. In the Cambie<\/em><\/a> case, owners of the Cambie private clinics are challenging BC\u2019s Medicare Protection Act<\/em>, which limits patients\u2019 use of private care and mandates that physicians must work in either the public-pay or the private-pay sector, but not both. The plaintiffs argue that these limits infringe on patients\u2019 Charter rights.<\/p>\n For those with good memories, the Cambie <\/em>case may be oddly reminiscent of the Chaoulli<\/em> case, which unfolded more than 13 years ago. Jacques Chaoulli, an orthopedic surgeon, claimed that Quebec\u2019s legislation restricting private duplicative insurance \u2014 private insurance for services already covered by the public plan \u2014 infringed on rights in both Canada\u2019s and Quebec\u2019s Charters. The Supreme Court of Canada did not reach a decision about the Canadian Charter right but ruled in favour of Chaoulli on the question of the Quebec Charter right.<\/p>\n To understand both cases and their real or potential impact, a reminder of the legal provisions that constrain the private purchase of health care in Canadian provinces will be helpful.<\/p>\n Doctors across Canada are prohibited from \u201cextra-billing\u201d or \u201cdouble dipping\u201d: charging patients for services already covered under our publicly funded medicare. Provinces are required by the Canada Health Act<\/em> to enforce legislation with those prohibitions, or they may face clawbacks of the federal Health Transfer. This is what happened in BC, for instance.<\/p>\n In most provinces, doctors are also prohibited from working<\/a> in both the public-pay and the private-pay health systems at the same time when providing publicly insured services. The concern is that such a \u201cdual practice\u201d could result in a conflict of interest, creating wait times in the public system in order to funnel patients to a more lucrative private practice. The bottom line: physicians in those provinces must choose to be either \u201call in\u201d the public system or \u201call out.\u201d<\/p>\n Like Chaoulli,<\/em> the Cambie <\/em>court challenge seeks to end the ban on duplicative insurance, but it also aims to break down the \u201call in\u201d or \u201call out\u201d dilemma for physicians, striking at the heart of BC\u2019s legislation by targeting all constraints on extra-billing, opted-out practice and dual practice. This broad scope makes Cambie <\/em>far more ambitious than Chaoulli <\/em>was at the time.<\/p>\n Still, many were concerned when Chaoulli won, and Quebec responded with Bill 33, which opened the door to private duplicative insurance for a small number of otherwise publicly insured health services that had long wait times. While Bill 33 turned out to be fairly innocuous (largely because private insurers did not deem this a profitable venture and the new law applied only to Quebec), it nevertheless responded to the spirit of the court challenge, sending a powerful message that Quebec\u2019s elected officials were, at least in principle, supportive of more private health provision and insurance.<\/p>\n C<\/em>haoulli <\/em>should thus really be seen as a symptom of Quebec\u2019s leniency toward the private sector, rather than a cause of the growth in Quebec\u2019s private health market, now arguably one of the largest such markets in the country. In fact, the cause was more neglect by legislators \u2014 whether benign or strategic, and for decades preceding Chaoulli <\/em>\u2014 that allowed several \u201chot spots\u201d of privatization to flourish. They include private diagnostic services, which are reimbursable by private insurance in Quebec, but not elsewhere in Canada; physicians opting out of the public system in ever increasing numbers, year after year; and extra-billing, which was officially banned by the province only in 2017 (after threats of clawbacks of the federal Health Transfer).<\/p>\n While BC has historical trends similar to Quebec\u2019s, we see no such benign neglect by BC legislators at present. Instead, the BC government appears to be fighting tooth and nail in the face of Cambie, <\/em>pulling out all the stops to buttress the Medicare Protection Act<\/em>. It even resurrected\u00a0 the Medicare Protection Amendment Act<\/em><\/a>, a law passed but not enacted 14 years ago, in a deft counterpunch to give the province more powers to crack down on extra-billing.<\/p>\n With both sides firmly entrenched in their positions, it is unlikely that we will see a swift resolution to the Cambie<\/em> conflict. Whichever side loses the court case is likely to bring it to the provincial appeals court, and from there to the Supreme Court of Canada, as happened with Chaoulli. <\/em><\/p>\n In other words, there\u2019s still a long battle ahead. However, the Quebec experience suggests that the impact of the Cambie <\/em>case on private-pay health care hinges critically on how forcefully and decisively the BC government signals its support of the Medicare Protection Act<\/em>. The court decisions matter, but, at the end of the day, it will be provincial governments\u2019 actions (or lack thereof) that open or shut the door to two-tier health systems across Canada.<\/p>\n Photo: Shutterstock, by janews<\/span><\/p>\n Do you have something to say about the article you just read? Be part of the\u00a0<\/em>Policy Options\u00a0discussion, and send in your own submission.\u00a0Here is a\u00a0<\/em>link<\/em><\/a>\u00a0on how to do it.\u00a0<\/em>|\u00a0Souhaitez-vous r\u00e9agir \u00e0 cet article ?\u00a0<\/em>Joignez-vous aux d\u00e9bats d\u2019<\/em>Options politiques\u00a0et soumettez-nous votre texte en suivant ces\u00a0<\/em>directives<\/em><\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Ask a random Canadian if our health care system looks more like that of the United States or the United Kingdom. Chances are, most will respond that our system is nothing like that of the US \u2014 which is largely paid for privately \u2014 and every bit like the UK\u2019s, which is publicly funded. The […]<\/p>\n","protected":false},"featured_media":274995,"template":"","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"apple_news_api_created_at":"2025-10-08T02:21:12Z","apple_news_api_id":"4a6081b5-b1c3-49b5-9154-ecbca1c86567","apple_news_api_modified_at":"2025-10-08T02:21:12Z","apple_news_api_revision":"AAAAAAAAAAD\/\/\/\/\/\/\/\/\/\/w==","apple_news_api_share_url":"https:\/\/apple.news\/ASmCBtbHDSbWRVOy8ochlZw","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":[],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false},"categories":[9372,9377],"tags":[],"article-status":[],"irpp-category":[4286],"section":[],"irpp-tag":[],"class_list":["post-266814","issues","type-issues","status-publish","has-post-thumbnail","hentry","category-recent-stories-fr","category-sante","irpp-category-sante"],"acf":[],"apple_news_notices":[],"yoast_head":"\n
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