UCP policy proposal could lead to costlier care

Two-tiered system would undermine medicare and break a promise, Lorian Hardcastle and Ubaka Ogbogu say.

The United Conservative Party annual general meeting on Oct. 16-17 will include a vote on whether to “support the option of a privately-funded and privately-managed healthcare system.” If passed and adopted by the government, this would create a two-tier health-care system whereby patients either receive care in the public system or pay for care privately (out-of-pocket or with private insurance). The UCP proposal undermines the foundational principle of Canadian medicare: access on the basis of need rather than ability to pay.

The proposed model, which is employed in countries such as Australia, New Zealand, and the United Kingdom, raises several concerns. Comparative evidence shows that private finance tends to pull health professionals away from the public system, causing waiting times in public hospitals to become longer. Those who can pay privately, often the healthy and wealthy, will receive faster care, while those who cannot afford private options or who are too ill to be treated in private facilities are likely to wait longer, thereby exacerbating health inequities.

Privately delivered care is also associated with poorer outcomes and higher costs.

The UCP proposal likely violates the Canada Health Act, which requires the federal government to withhold, on a dollar for dollar basis, any amount that a government permits in extra billing or user charges. Extra billing occurs when a doctor both bills the government for providing an insured service and charges the patient an additional fee. User charges are other fees patients pay to receive insured services.

Provincial laws operationalize the Canada Health Act by limiting private finance in various ways. One such provincial law was the subject of a recent case (Cambie Surgeries Corporation v British Columbia). The plaintiff, Brian Day, is an orthopedic surgeon and the founder of a private surgical facility that billed patients in contravention of B.C. law. He alleged that the combination of laws limiting private finance and long wait times violated the Canadian Charter of Rights and Freedoms. As a result of Cambie's illegal billing practices, the federal government withheld over $32 million in transfer payments from the B.C. government over a twoyear period.

Although the Cambie decision suggests that provincial restrictions on private finance are likely constitutional, neither the Canada Health Act nor the Charter prohibit private finance. However, if the UCP vote passes and is implemented by the government, there will likely be financial repercussions for flouting the Canada Health Act.

The Alberta government has already taken steps toward carving out a greater role for private entities within the health-care system, including privatizing laboratory services, permitting corporations to bill the government for health services that they contract with doctors to provide, and significantly increasing the number of publicly-funded surgeries delivered in private facilities. The government is engaged in discussions about a $200-million private facility that would perform most orthopedic procedures in the Edmonton region.

The UCP has also shown its willingness to depart from the principles of the Canada Health Act. At last year's annual general meeting, members voted against a proposal that all reforms to Alberta's healthcare system must comply with the Canada Health Act. Since then, Premier Jason Kenney has affirmed his reluctance to participate in federal/ provincial cost-sharing programs for health services by stating that he would not support a federal pharmacare program.

Given the UCP'S receptiveness to privatization and willingness to depart from the Canada Health Act, the resolution permitting private finance may well be approved. As for whether it will be implemented by the government, Minister Tyler Shandro has said that he takes “no position” on this issue. While he committed to retaining a public insurance plan, he did not explicitly rule out a parallel private tier where patients can pay to jump the queue.

Regardless of what side one takes in the ongoing debate on the evolution and sustainability of Canadian medicare, one thing is clear: the UCP proposal would be a step toward a costlier and less equitable health-care system. Given that Albertans were promised and voted for “a universally-accessible, publicly-funded health care system,” the next provincial election provides an opportunity to hold the government to this promise, or to affirm its betrayal.

Lorian Hardcastle is an associate professor in the faculty of law and Cumming School of Medicine at the University of Calgary.

Ubaka Ogbogu is an associate professor in the faculties of law and pharmacy and pharmaceutical sciences at the University of Alberta and a Pierre Elliott Trudeau Foundation Fellow.

The opinions expressed are those of the authors and do not represent those of the Pierre Elliott Trudeau Foundation.