Globe and Mail

Canada may move toward U.K. systemBy ALAN FREEMAN

Friday, June 10, 2005 Page A10

 WASHINGTON -- Health care in Canada is likely to become a lot more like
Britain's two-tier system as a result of the Supreme Court of Canada's
ruling that struck down Quebec's ban on private health-care insurance,
several international experts say.

The health-care experts say wealthier Canadians will soon be jumping the
queue for operations like hip replacements and other elective procedures by
going to private clinics and hospitals, just as they do in Britain, where
about 12 per cent of the population has private health insurance.

And rather than get shorter, the waiting lists at public hospitals could
get even longer as already scarce doctors, nurses and other health workers
migrate to the better-financed private sector, some critics say. Others
disagree, arguing that more spending on the private sector will free up
money for public hospitals.

But when it comes to serious illnesses, Canadians are likely to stick with
the public system, because no business will be willing to spend huge sums
to build and operate the complex facilities needed for that kind of care.

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 The result will be the end to the equity that Canadians have sought in
their system, where everyone waits for the same health service in the same
public institution, said Robert Blendon, a professor of health policy at
Harvard University,

"Canada is fighting this battle that other countries have lost," he said,
predicting that within a decade, every city in Canada will have at least
one private hospital and several private clinics where richer people will
get faster service.

"What you'll see are gall bladders, hips and various eye procedures" done
privately, he continued.

The growth of a private sector parallel to a public one has occurred not
only in Britain, but also in Spain and Germany. "It clearly allows people
who can afford the insurance to get in faster and get out," Prof. Blendon
said.

Colleen Flood, who teaches health policy at the University of Toronto law
faculty, worries that the ruling will mean a huge diversion of resources
from the public to the private sector that will make the situation worse
for most patients.

"It could exacerbate the waiting lists because there will be fewer doctors
in the public sector with less time to spend in the public sector," she
said. "The private system will become parasitic, doing the really easy
stuff," while leaving expensive diseases like cancer and heart disease to
the public sector.

She cites her native New Zealand as an example. About 30 per cent of the
population has private health insurance and the waiting lists in the public
sector are even longer than they are in Canada.

In defending its restrictions on private health insurance, the Quebec
government argued that allowing the private sector to grow would cause
terrible damage to the public system. The court disagreed, citing the fact
that the two systems co-exist in many parts of the world.

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