EPOCH TIMES COLUMN: Supreme Court’s Decision Will Hurt Patients in Canada

Recently, the Supreme Court of Canada announced it was not willing to hear an important health-care court case. Patients should know, the court’s decision is anything but good news.

Dr. Brian Day, founder of the Cambie Surgery Centre in British Columbia, was hoping to build on a 2005 Supreme Court ruling that found it was unlawful for the Quebec government to force patients to wait long periods for health care while also banning private options.

The Supreme Court then famously noted: “access to a waiting list is not access to health care.”

Following that decision, private health care options grew in Quebec. For various reasons, patients cannot pay for whatever procedure they want in “La Belle Province,” but Quebecers do have the option of going to a private clinic to pay for many common surgeries, such as knee and hip operations. (Quebec patients can of course continue to use the public system if they so choose–and most do.)

Back in 2009, Dr. Day began a legal challenge against legislation in British Columbia that also restricted patients’ access to private health care. Considering the Supreme Court had ruled just a few years prior that private health care bans violated Quebec’s provincial Charter of Rights, and although decision was split on whether it also violated Canada’s Charter of Rights, many expected Dr. Day’s court challenge to be fairly straightforward since a precedent had been set and people in one Canadian province were assured certain rights.

Fast forward 14 years and Day’s case finally made its way to the Supreme Court of Canada. But despite what should have been an easy decision, the court announced on April 6 that the case would not be heard.

Thus, Canada is now in a position where the Supreme Court has awarded Quebecers more health-care rights than the rest of the nation. At the same time, the highest court in the land has signalled that it has no plans to change this disparity.

Patients should know that health-care systems that outperform Canada allow patients a choice: use the public system or pay out-of-pocket for private care. Australia, New Zealand, Sweden, Norway, Japan—they all give patients a choice. No other developed nation on earth bans private health care like Canada does.

While Canada remains trapped in an ideological health-care straightjacket, other nations understand that by giving patients a choice, some will decide to pay for private care. When that happens, there is less pressure on their public system. Simply put, each time a patient pays for a private MRI scan or hip operation, that’s one less case the public system has to worry about.

It would be foolish to expect Ottawa to step up and pass legislation to give Canadians in the rest of the country the same rights as Quebec patients. Our federal government has, after all, taken a rather extreme position when it comes to health care. They expect all Canadians to wait together in misery while provincial governments continue to fumble around and slowly ration health services to the public.

In fact, the federal government recently announced $74 million in fines for provincial governments that allow patients to pay for diagnostic scans at private clinics if they don’t want to wait for the public system. If provincial governments cave under Ottawa’s pressure and shut down private diagnostic clinics, then we’ll see even more patients flooding into the government’s system. In other words, longer wait times.

In the meantime, patients will continue to suffer, face worsening health conditions, and even die.

SecondStreet.org has gathered government data from across the country showing at least 41,620 patients have died while waiting for surgery and diagnostic scans since 2018-19. Many of these patients died while waiting for procedures which could have improved their quality of life (e.g. hip operations) in their final years, but the data also includes cases where patients died while waiting for potentially life-saving treatment.

For instance, retired Ontario nurse Judy Anderson told SecondStreet.org about how her daughter Shannon died while waiting for a potentially life-saving heart procedure in 2021. After waiting as long as she could, Shannon eventually called her family over to her house, said her goodbyes, and checked in to the hospital the next day. A few days later, she was gone, leaving behind four children.

It’s unacceptable that Canada’s top court has essentially created rights for patients in one province, but has decided against extending those rights to the rest of the country.

Perhaps if you’re a six-figure-salary Supreme Court judge with a golden pension, you don’t need to worry about health care–you have the means to skip long waiting lists by simply travelling to another country for faster treatment. But for the rest of us, we could certainly do with more choice. And isn’t the system supposed to be about patients?

Colin Craig is the president of SecondStreet.org, a Canadian think tank.

This column was originally published by the Epoch Times on April 6, 2023.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.