Canada's Supreme Court dropped a political bombshell on Thursday by ruling that a Quebec chemicals salesman is entitled to seek private health insurance to pay for a hip replacement operation, even though such coverage is forbidden under the public healthcare system.
The judgement is sure to increase pressure for wider private-sector involvement in a healthcare system that many Canadians regard as one of their country's defining characteristics and the most important distinction between Canada and the US.
"This could substantially change the very foundations of medicare as we know it," the Canadian Medical Association's president Dr. Albert Schumacher said.
The present system is based on the principle that all Canadians should have equal access to medical care, whatever their income and wherever they live.
Proponents have fought private insurance and private medical services on the grounds that they would create a US-type “two-tier” system benefiting the wealthy, and sucking the best doctors and nurses out of public hospitals.
But criticism has mounted as waiting lists for some types of surgery have lengthened, in spite of healthcare absorbing an ever-larger share of the 10 provinces' budgets. The provinces have jurisdiction over healthcare services.
Conservative governments in Alberta and British Columbia have quietly moved towards a mixed, European-type system, for instance, allowing privately-owned clinics to provide some services covered by public insurance, such as cataract removals.
But doctors are still typically barred from seeing private patients in public hospitals and private insurance is forbidden for services covered by the publicly funded system.
The case decided on Thursday was brought by Dr Jacques Chaoulli of Montreal on behalf of a patient who had to wait over a year for a hip replacement under the public insurance system.
Dr Chaoulli, who was trained in France, has campaigned for over a decade against the current restrictions, arguing that they violate a patient's basic rights. Two Quebec courts previously ruled against him, and many legal experts gave him only an outside chance of winning his appeal.
In their ruling, a narrow majority of the Supreme Court judges concluded that “the benefits of the prohibition (on private health insurance) do not outweigh its deleterious effects. The physical and psychological suffering and risk of death that may result from the prohibition on private health insurance outweigh whatever benefit - and none has been demonstrated here - there may be to the system as a whole”.
