Medicare (Canada) - Parallel Private Debate

Parallel Private Debate

Some politicians and think tanks have proposed removing barriers to the existence of a parallel private healthcare system. Others note that such systems act to erode cost control and impede equity. Though polling suggests support for such reforms has been increasing, it has yet to be adopted as official policy by any of the main federal political parties.

Under federal law, private clinics are not legally allowed to charge patients directly for services covered by the Canada Health Act, if they qualify for the public insurance. Regardless of this legal issue, many do offer such services. There are disputes as to whether surgical procedures can be performed. Two related issues have obstructed the growth of such clinics. One is regulatory — hospital-based quality assurance often failed to encompass them. This gap has been filled in most provinces, but sometimes only after celebrated incidents in which patients died in unregulated clinics, including one physician who performed cosmetic surgery in an Ontario hotel room. The second is economic — there may be no way for physicians to recoup the additional costs of running a surgical facility from their fees. Here, provinces can choose to offer 'facility fees' to these clinics, but doing so has often been contentious, particularly if hospitals felt that these costs would be better devoted to allowing them to increase their operating room time.

Note that uninsured persons can pay for care (including medical tourism), and that insured persons can still pay for uninsured services. These are both niche markets.

Opponents of Medicare often raise issues such as long wait times, a 'brain-drain' drawing qualified professionals away from Canada to other jurisdictions where working in the health care field is more profitable, and impairment of the Canadian health care system due to budget cuts. Fox News ran a story in 2007 reporting that during a period of above average numbers of births, at least 40 Canadian mothers of premature babies had to travel to the U.S. for treatment due to insufficient capacity for premature babies in British Columbia neonatal units. Nonetheless, Canada's Medicare system covered the health care costs of those mothers affected.

In 2003, the Government in Canada spent $2,998 USD per capita on healthcare as compared to $5,711 USD per capita in the United States, while almost every Canadian citizen is fully covered. In the United States a high percentage of the population is uncovered or only marginally covered, despite higher proportional spending along with large private investment.

The lack of competition has given healthcare unions a monopoly on essential services, thus ensuring a very strong bargaining position. Nova Scotia is currently debating healthcare legislation aimed at removing the threat of striking healthcare workers and replacing it with binding arbitration.