Once upon a time the term private health care had a different meaning. It meant a patient was free to choose their own medical doctor. A doctor was free to set the price for providing their skills. It meant a private contract formed between a patient and their doctor for medical care, the price of which would be settled between them. It meant a patient and doctor were accountable to each other.
Then, during a few blinks of the eye and with the subtleness of an unskilled magician, the fabric of medicine was pulled from the table along with all of the delicate pieces adorning it. It was the disappearance of private health care’s true meaning.
In Canada, legislation prohibits patients from directly paying for any publicly insured “medically necessary” hospital and physician services. The Canada Health Act of 1984 includes two conditions prohibiting “extra billing” and “user charges” for these health services. Provinces and territories that do not abide by the conditions are penalized by the withholding of federal funds equal to the amounts received through these practices.
Each province and territory has enacted legislation which either bans or effectively deters “extra billing” and “user charges”. Depending on the province or territory, doctors wishing to “opt-out” or practice outside of the public plan are either 1) prohibited from charging the public plan anything for their services or 2) prohibited from charging any amount above what the public plan will pay for their services. Patients of doctors practicing outside of the public plan would receive no public funds towards their private purchase of publicly insured services. They would essentially be opted-out of the public plan despite contributing to it through taxation.
All provinces and territories have legislation that either bans the purchase of private insurance for publically insured services or deters patients and doctors from opting-out of the public plan so that there is effectively no market for private insurance.
As of March 31, 2008 there were approximately 49 doctors in Canada (excluding Quebec) practicing outside of the public plan. Forty of them are located in Ontario.
Government remains the single-payer for all “medically necessary” services for Canadians. In this role they alone decide the value of these services, the provision of these services as well as measure and assess their quality.
Provincial and territorial laws can be changed and the health care insurance industry is not yet firmly entrenched in every aspect of our health care system. Canada is in a unique position to return the true meaning of private health care to its rightful owners – patients and their doctors.
You can find out more about provincial and territorial health care by reading the most recent Canada Health Act Annual report.
This is a very incomplete picture of Canada before medicare. In 1965, only 51% of Canadians had health insurance covering physician and other non-hospital services. So the precious relationship between patients and doctors that you’ve described here was certainly not available to all citizens.
Today, only 51% of working Canadians have employer-sponsored extended health benefits that support access to services which fall outside of medicare. But the distribution of those benefits is very uneven. For example, fewer than 22% of working people under the age of 25 are covered by private insurance, only 47% of female employees, fewer than 20% of low-income earners. Many of those who have extended health benefits confront high deductibles and copays.
In addition, as a review of the Canadian Human Rights Act put it, employers and insurers are able to “make numerous distinctions based on prohibited grounds of discrimination to control risks that insurers and employers feel are necessary to limit costs to keep plans affordable”. These “distinctions” are based on age, sex and disability – and, of course, ability to pay – all of which are prohibited under public health insurance laws and regulations. Thus many of the very people who are most likely to need physician and other forms of medical treatment are among the most likely to face discriminatory barriers to accessing private insurance benefits.
Colleen,
You make some good points regarding access to health insurance but a government monopoly on health care and mandatory public health insurance not only limits an individual’s freedom of choice in the quality, quantity and price of their medical care, it also exacerbates problems within these areas. Restoring the medical freedoms of patients and doctors is the first step to making improvements in the relationship between them and to providing future direction for our health care system.