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WINNIPEG FREE PRESS COLUMN: Supreme Court decision will hurt patients

If a patient in Quebec needs breast cancer surgery, a hip operation or any other health services, they have two choices: wait for the government’s health-care system to provide it or pay for the operation at a local private clinic.

The Supreme Court of Canada, however, recently denied that same choice to the rest of the country.

In every other province, patients have no choice but to wait for the government to provide medically necessary services or travel outside the province for treatment. This double standard — created by the Supreme Court — makes no sense. It’s not only inconvenient for patients, it will cause harm to many — perhaps even costing some their lives.

Ironically enough, it was a Supreme Court decision from 2005 that opened up private health-care options in Quebec. The Chaoulli v Quebec case famously concluded: “Access to a waiting list is not access to health care.” The courts ruled that the Quebec government can’t operate a monopoly on health services while also making patients wait unreasonably long periods of time for surgery. This decision only applied to Quebec because the courts ruled that the ban on private care violated the Quebec Charter of Human Rights and Freedoms.

Since that time, a British Columbia doctor, Brian Day, spent 14 years fighting for B.C. patients to receive the same rights the courts granted to Quebecers. Despite his long and costly battle, the Supreme Court refused to even listen to his case. It didn’t even grant him the courtesy of an explanation.

Thus, the Supreme Court has granted one set of health-care rights for Quebecers, and a different set for the rest of the country.

Readers should note that countries with better performing health-care systems — Sweden, Norway, Australia and France to name a few — allow patients a choice: use the public system or pay for services at a private clinic. It’s no coincidence that these same countries also have shorter wait times — private options take pressure off their public systems.

For Ontario breast cancer patients, having this choice is important. The Ottawa Citizen ran an article recently that examined why more and more Ontario cancer patients were travelling to Quebec to pay for private surgery. It turns out they were concerned about dying as the government was taking too long to provide surgery. Go figure.

Dr. Jean Seely, a radiologist at The Ottawa Hospital, told the Ottawa Citizen that the delays in Ontario, “will have an impact on significant loss of lives to breast cancer until they are addressed.”

Having more choice means patients can also avoid waiting in chronic pain for a year or two while the state gets around to providing services like hip and knee surgery.

Of course, there are opponents to giving patients a choice between public and private care. Their most common argument is that private clinics would steal staff from the public system. It’s a strange argument to suggest that other nations can figure out how to prevent this problem, but Canadians cannot.

In the United Kingdom, for instance, the government caps how much a doctor can earn at private clinics to no more than 10 per cent of gross salary. This option could help ensure stability until Canadian universities and colleges train more health-care workers. Post-secondary institutions could prioritize training such staff, perhaps by redirecting money away from degrees with low employment rates after graduation.

Private clinics could also recruit some of the thousands of Canadian health care workers who live in Canada but commute to the U.S. for work (or are thinking of moving south). New research by SecondStreet.org shows that nearly 2,000 Ontario nurses regularly commute to work in Michigan alone.

To be sure, allowing patients more choice won’t solve all our country’s health-care woes. But it will take pressure off our struggling system, while helping countless patients get the care they need. It’s not acceptable that the Supreme Court only thinks Quebecers deserve this option.

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

This column was published in The Winnipeg Free Press on May 12, 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.