Opinion by James D. Roumeliotis
As a Canadian citizen of a country that was once very proud our health care system, nowadays I’m greatly disappointed with its mediocre state of affairs.
As an advocate of a dual health care system, as I had experienced firsthand with such a structure in both Greece and France, I’m convinced that it’s a practical model for both the citizens (when it comes to choice and timely access) and the government (less burden from a monetary and management perspective).
The Canadian province of Quebec, where I presently reside, is considered the worst province in the country when it comes to access for family doctors and front-line care. There is strong evidence of a structural problem. The long waiting times in the emergency, the waiting lists with elective surgeries, and a short supply of personal physicians is frustrating to say the least. This situation may pose a health risk, hence, prompts calls for the right to add private health care that runs alongside the existing one.
In 2007, with pressures mounting from the public, the Quebec provincial government made mandated an independent commission to write a report about the state of health care and make sound recommendations. Following its thorough research, the commission, recommended the development of a parallel private system based on the European experience as the only way financially to salvage/save health care in Quebec. Incidentally, the person who headed the inquiry, Mr. Claude Castonguay, was one of the pioneers of the province’s socialized medicine dating back in the 1970s when he served as Quebec’s health and social affairs Minister. Sadly, most of the report was publicly dismissed by the government of the day.
A parallel private system functions very well in most European countries and there’s no collapse of the public system contrary to those who argue that this could potentially lead to the dismantling of our existing Medicare model. To prevent doctors from abandoning the public system, the Castonguay Commission envisions having doctors perform a mandatory minimum quota of work in the public sector before they would be allowed to perform in the private sector.
The public system should always function and be accessible for those who can’t afford the private health care system. However, no one should be forced to use it as is the case today.
Co-existence of the public and private sectors through a mix of co-payments (partial direct payments from those receiving treatment), private service providers paid for with public funds, as well as from private insurance plans. Among the practices to consider: The Netherlands operates with private medical insurance for all, governed by law to safeguard the principles of universal access. Denmark offers a guaranteed start of cancer treatment within 48 hours of diagnosis and Belgium has a “no wait times” policy along with equality of access and freedom of choice — packaged with a 25-per-cent user fee and capped for low-income earners.
In France, 60 per cent of elective surgery is done in private establishments, but paid for with public funds. As this is working properly, the French are naturally very proud of their system.
In 2005 a Canadian Supreme Court decision, from a lawsuit brought by a Quebec patient and his doctor (George Zeliotis and Dr. Jacques Chaoulli respectively) proved to be highly controversial due to both its political nature and its conflict with the present government’s policy on health. The verdict clearly stated that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under Medicare. It’s considered unconstitutional under the Quebec Charter of Rights. The 73 year old retired salesman, Mr. Zeliotis, was fed-up having to be placed on an eight month hospital waiting list for a hip replacement surgery. This prompted the lawsuit along with his personal physician who fully supported his cause.
This ruling would have a direct effect on most provinces that currently have laws that are designed to discourage the private sector, in particular Ontario, Manitoba, British Columbia, Alberta, and Prince Edward Island, which all have legislation very similar to the impugned laws in Quebec.
The implicit message from Supreme Court verdict is loud and clear: Anyone should have access to private-sector health services and private medical insurance in circumstances where patients cannot obtain timely access to care through the existing social health care system.
What the Canadian health care system needs is not more money to be spent, but better management and choices for its citizens. There is no perfect system. At least for now, the province should pay for private treatment if the patient isn’t treated within a certain time frame.
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