gloomy and/or hopeful monologue

2月 21, 2006

[IHT] Canada taking small steps toward private health care

Filed under: healthcare, iht — Sato Atsushi @ 11:55 pm

Canada taking small steps toward private health care – Americas – International Herald Tribune

TORONTO The cracks are still small in the vaunted Canadian public health insurance system, but several of the largest Canadian provinces are beginning to open the way for private health care eventually to take root around the country.

Canada taking small steps toward private health care
By Clifford Krauss The New York Times

TORONTO The cracks are still small in the vaunted Canadian public health insurance system, but several of the largest Canadian provinces are beginning to open the way for private health care eventually to take root around the country.

Last week, the Quebec government proposed to lift a ban on private health insurance for several elective surgical procedures and announced it would pay for such surgeries at private clinics when waiting times at public facilities were unreasonable.

The proposal, by Premier Jean Charest, who called for “a new era for health care in Quebec,” came in response to a Supreme Court of Canada decision last June that struck down a Quebec law that banned private medical insurance and ordered the province to initiate a reform program within a year.

The Supreme Court decision ruled that long waits for various medical procedures in the province had violated patients’ “life and personal security, inviolability and freedom,” and that prohibiting private health insurance was unconstitutional when the public health system did not deliver “reasonable services.”

The decision applied directly only to Quebec, but it has generated calls for private clinics and private insurance in several provinces where governments hope to forestall similar court decisions.

Coincidentally last week, the lieutenant governor of British Columbia, Iona Campagnolo, speaking for the provincial government, said in a Throne speech, the equivalent of a state of the province address: “Does it really matter to patients where or how they obtain their surgical treatment if it is paid for with public funds?”

It was a question that was almost unthinkable for a government in Canada to ask before the Supreme Court decision last year. Public health care has long been considered politically sacrosanct in Canada, and even central to the national identity.

Campagnolo presented the British Columbia government’s vision for a new provincial health care system that would resemble those in most of Western Europe, where governments pay for essential treatment delivered in both public and private clinics and hospitals.

Premier Ralph Klein of Alberta, recently expressed a similar goal. His government is promising legislation to permit doctors to work simultaneously in private and public institutions and to allow the building of private hospitals.

Quebec, the second most populous province in Canada, has not decided to go that far. Forced by the court to meet a one-year deadline for a plan to change the system, Charest proposed limited, but important changes.

He proposed that private insurance cover knee and hip replacements and cataract eye surgery. Publicly run hospitals would be allowed to subcontract to private clinics for such procedures if the hospitals were unable to deliver the services to a patient within six months. The plan is to be introduced in the provincial Legislature for passage before the summer.

“We’re putting the private sector to work for the public,” Charest said. “We’re taking a measured step in this direction.”

Charest and the Quebec health minister, Philippe Couillard, called for an open debate and did not rule out more privatization in the future. Quebec already has about 50 private health clinics, far more than any other province, but doctors would remain forbidden to serve in both the private and public systems under the Charest plan.

Antonia Maioni, a McGill University political scientist who specializes in health care, said Charest had to be careful about pushing too hard for privatization because of potential opposition from unions and liberal groups.

“They are trying to stay politically afloat,” Maioni said, noting Charest’s low standing in opinion polls only a year or two before the next provincial elections. “The winds of change are blowing, but they are not knocking everything over.”

The Canadian prime minister, Stephen Harper, a Conservative elected last month, did not propose a sweeping overhaul of the health care system while campaigning for election. But he said he did favor guaranteed waiting times for services.

As a free-market conservative, he is thought to favor the Supreme Court decision and will probably try to use it to encourage changes.

The outgoing Liberal government opposed fundamental changes. But the new health minister, Tony Clement, is a proponent of looking for ways to reduce waiting time, to modernize equipment and to increase the supply of doctors.


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