Textes d'opinion

Allowing private health insurance would ease Canadians’ suffering

There are more than 660,000 Canadians waiting for surgery at the moment, with many waiting long months and even years.

For these people, each day stuck on a waiting list is 24 more hours of sore knees, or pain when walking, or other such ailment or debilitation, with the knowledge that their condition could well be deteriorating.

And we know these people: they’re our friends, our neighbours, our colleagues, and our parents.

Unless they have enough money to go abroad or have the means to pay out of pocket to go to a private clinic, waiting is their only option.

It is unfortunately not possible to take precautions against such an eventuality with an insurance policy, either. In Canada, if a treatment is covered by the governmental health insurance plan, you will not find any private insurance covering that treatment.

And yet, this is not the norm for countries with universal health insurance. In the United Kingdom, Sweden and Australia, to name just a few, a market exists for so-called duplicate health insurance that provides access to private treatment options, even if those treatments are covered by the governmental system.

The beneficial effect is twofold, as these insurance policies allow the insured to avoid languishing on waiting lists for governmental health care treatment, all while relieving pressure on the local public system.

And people seem satisfied. In Australia, for example, almost one in two people has such a policy. This therefore allows a sizable share of the middle class to have access to care in the private sector when the public sector is not keeping up with the demand.

The rate of satisfaction for these plans is 73.7 per cent according to a poll conducted in 2020 of more than 25,000 Australians.

In comparison, a recent poll found that 49 per cent of Canadians are dissatisfied with their provincial health-care system.

You can’t buy duplicate insurance here, but it’s not because there’s no demand or market for it. Rather, it’s because it’s either prohibited outright, or there’s a set of laws that makes it uninteresting for insurance companies to offer such a product.

Currently, only four provinces allow such plans to exist: Nova Scotia, New Brunswick, Saskatchewan, and Newfoundland and Labrador.

These provinces likely do not have sufficiently large populations to make it worthwhile for companies to offer duplicate insurance. Saskatchewan, the largest of them, has just 1.2 million inhabitants. That’s about as many as in the Ottawa metropolitan area, if you don’t include the city of Gatineau.

To this are added restrictions on billing, and the banning of mixed practice, making it difficult for a market to develop.

Then there’s Quebec, where duplicate health insurance was authorized for just three very specific procedures following the Chaoulli decision. For all other procedures, the law formally prohibits duplicate insurance.

Unsurprisingly, an insurance market has not developed just for total hip or knee replacement, or cataract extraction with intraocular lens implantation. These procedures are too specific, too limited, for a critical mass of the population to choose to insure themselves.

The five other provinces have not complicated things with exceptions, simply prohibiting the sale of such insurance completely.

The result is that, for the vast majority of Canadians, the only treatment option is to languish on the waiting lists that have become characteristic of our provincial health-care systems.

But as former Supreme Court chief justice Beverley McLachlin noted, “Access to a waiting list is not access to health care.”

For 660,000 of our fellow Canadians, the inaccessibility of care is anything but theoretical. They live it every day as they wait for their operations. It’s a safe bet that many of them would choose to be treated in the private sector, if insurance lowered the financial barriers to doing so.

After all, waiting is never fun, but it’s worse when you’re in pain.

The best thing our provincial governments could do to help is to allow other options, like duplicate insurance, so that patients can better access the care they need.

Maria Lily Shaw est chercheuse associée à l’IEDM et l’auteure de « Lever l’interdiction touchant l’assurance maladie privée duplicative au Québec ». Elle signe ce texte à titre personnel.

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