By Colleen M. Flood and Dr. Jane Philpott
The Cambie decision was recently released by Justice Steeves of the British Columbia Supreme Court after 93 days of argument and 101 witnesses. In a whopping 880-page decision, Justice Steeves found that BC laws putting limits on a two-tier health system do not contravene the Charter of Rights and Freedoms.
Arguments centered on whether permitting doctors to be paid by public medicare and simultaneously bill patients directly, or through private insurers, or all three, is a good idea.
Should people be able to pay or use private insurance to jump the queue for hip or knee operations, regardless of their medical urgency? Should doctors be able to “extra-bill,” namely, bill the public plan and then charge the patient extra and permit patients to buy private insurance to cover the cost?
Much hinged on whether such practices are likely to make things worse for the majority of Canadians who would be left behind in the public system. After reviewing a tremendous amount of evidence, Justice Steeves concluded that giving license to doctors to bill extra on top of billing medicare does not solve the problem of wait times, it would likely exacerbate them.
This decision has the potential for far reaching effects on our public healthcare system in British Columbia and beyond. The outcome is so important for the future of medicare it may well be appealed, potentially all the way up to the Supreme Court – whether by the private clinics or the doctors spearheading the challenge, who have much to gain financially from a two-tier system.
Regardless of this positive outcome for public medicare, the public system must improve wait times.
Pre-COVID-19, many Canadians were concerned about the long waits for some kinds of care. Now, with so many procedures having been cancelled during the first wave of the pandemic, these concerns have become even more acute for some.
Of course, there is also nothing like a pandemic to remind us all of the critical need for a strong, well-funded public health care system that takes care of every single Canadian based on need, rather than ability to pay.
But the worries about wait times are real and must be addressed.
Such worries undoubtedly fuel a misguided sense that more private pay will be the cure – a sense that is capitalized upon by those seeking to make a profit. Canadian governments, health system leaders, providers, and even communities have, for far too long, done far too little to respond to concerns about wait times fuelling the fire of the Cambie litigation.
Part of the problem is the assumption that the only way to fix wait times is to pour more money into the system. More doctors, more hospital beds, more expensive equipment – at times it feels like the resource needs can never be met.
Of course, sometimes more money is needed – but the evidence is clear that fixing wait times, including for the kinds of procedures at issue in the Cambie trial, does not require endless new resources. Successful projects across the country, such as e-consult services, the youth mental health efforts at two Ottawa hospitals and Dr. Cy Frank’s wait-time initiative for orthopaedic procedures in Alberta show that when specialists come together to share a wait list rather than each keeping separate lists, patients are seen faster.
Teams that involve non-physician professionals, like nurses, pharmacists, physiotherapists and more can also see people more quickly. Across the country, innovative approaches have been very successful at reducing waits without sacrificing the value of equity that Canadians hold so dear.
The Canada Health Act speaks to “reasonable” access to health care. Most Canadians would likely think that this means “reasonably timely” care. The work of getting there is tough – it requires leadership on the part of governments, system leaders, doctors and more – and allowing wealthy Canadians to pay for faster care will not change that.
It is time for provinces and territories working with health care providers to step up and spread and scale all the good solutions we already know about so that patients’ needs are coordinated through central triage structures and no patient falls through the gaps.
Private payment is no real answer, as Justice Steeves has definitively concluded. Solving wait times is.
Colleen M. Flood FRAC, FCAHS is Director of the Centre for Health Law, Policy and Ethics and University Research Chair at the University of Ottawa.
The Hon. Dr. Jane Philpott is a former Federal Minister of Health and Dean of the Faculty of Health Sciences, Queen’s University.
Photo: Tingey Injury Law Firm, Unsplash