Will Canadian courts put an end to the public health care monopoly?

Montreal, November 19, 2015 – A legal challenge will soon be underway in British Columbia that could profoundly change the Canadian health care system, by making more room for the private sector and for patients’ freedom of choice. To shed some light on this case, the MEI is publishing today a Research Paper on legal challenges aiming to change Canada’s health care policies.

The difficulty of accessing health care in British Columbia has prompted a group of patients to contest the legitimacy of the government’s monopoly. The case is being spearheaded by Dr. Brian Day, a former president of the Canadian Medical Association, who wants patients to be allowed to use their own resources to be treated in the private sector, as is the case in all other countries. Six patients joined the case starting in 2012, but only four remained in November 2015, the others having died while awaiting the hearing. One of the four, Walid Khalfallah, a teenager with a particularly severe form of scoliosis, is now paraplegic, having been unable to obtain the required surgery in a timely fashion.

The petitioners are basing their challenge on the Chaoulli decision rendered in June 2005, in which the Supreme Court of Canada ruled that the prohibition on taking out private health insurance violates patients’ right to life and security and runs counter to Quebec’s Charter of Human Rights and Freedoms.

Yet very little has changed in Quebec since this decision. The law was indeed changed, but by limiting the number of admissible surgeries, the government prevented the development of a private insurance market. Nearly one patient in five must still wait over six months for a hip or knee operation, and average wait times for elective surgeries have not seen any notable improvements since 2008.

In British Columbia, the plaintiffs want the prohibitions on duplicate private health insurance to be lifted, and mixed medical practice and the free determination of doctors’ fees to be allowed. The Research Paper explains the ins and outs of this case, while reminding readers that the government remains unable to provide timely access to care, though it maintains its strict monopoly over the provision of medical care.

Canada is still an exception among industrialized countries, where duplicate private insurance is widely available. Canada is also alone in prohibiting its doctors from practicing in both the public sector and the private sector. Finally, whereas 99% of hospitals in Canada are public, in all other countries, private medical facilities play a prominent role in the provision of hospital services.

Some fear that a victory for the plaintiffs in the Day case would herald the end of universal care, and open the door to a “two-tier” system. But nothing could be further from the truth, points out Yanick Labrie, author of the Research Paper. “If the plaintiffs should win their case, the Canadian system would not thereby come to resemble the American model, but rather the most efficient mixed universal systems in the world, in particular those found in Europe,” he says.

“There is no justification for maintaining a government monopoly in the provision of medical care, and there is every reason to adopt reforms inspired by Europe’s mixed universal systems, which are far more accessible than ours,” concludes Mr. Labrie.

The Research Paper entitled The Public Health Care Monopoly on Trial: The Legal Challenges Aiming to Change Canada’s Health Care Policies was prepared by Yanick Labrie, Economist at the MEI. This publication is available on our website.

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The Montreal Economic Institute is an independent, non-partisan, not-for-profit research and educational organization. Through its studies and its conferences, the MEI stimulates debate on public policies in Quebec and across Canada by proposing wealth-creating reforms based on market mechanisms.

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