The Cambie Case is an important policy decision with massive impact on our cherished public healthcare systems that many Canadians are not familiar with. Adjudicated in British Columbia, this four-year-long trial began in 2016 and ended in 2020. Fortunately, the Provincial Court of BC recently made the decision to rule against privatizing health care financing.
Why is this case a concern to us? This case essentially challenged the rights of patients, putting fair and equitable access to healthcare in jeopardy. Briefly, the plaintiffs of the case wanted to overturn three key aspects of BC’s Medicare Protection Act (MPA):
- Extra billing and user fees, allowing doctors to charge patients more than what was listed under the public insurance plan.
- Private duplicate insurance, where doctors would be allowed to bill private insurers for patients who want faster access to hospital and physician care.
- Dual practice, giving doctors enrolled in the public plan the opportunity to choose whether to bill only the public plan, patient (or private insurer), or both for any service covered by the public plan.
These three changes would be a reversal of the progress made by the 1985 Canada Health Act which was put in place to stop doctors' extra billing. These changes would also create huge inequities in access to healthcare services, as only those who could afford it would be able to access adequate care. This would also mean doctors would have more of a financial incentive to provide access to those who have private insurance, or those who could afford to pay out of pocket, over those who cannot afford either private option.
Evidence from Australia demonstrates that shifting towards privatization actually worsens the health system. Australia introduced private duplicative health insurance with the claim that it would help to reduce wait times. However, those changes had the opposite effect. Wait times grew longer, especially for those who could not afford private insurance.
The Cambie Case not only put the healthcare system in BC at risk but health systems across Canada as a whole. Without a doubt, if the plaintiffs had won their case, the door would have been open for other provinces to follow suit and move toward privatization. Canadian Doctors for Medicare saw this push to change the BC MPA as a danger to the Canada Health Act, essentially causing it to be unenforceable among other provinces.
Recently in Ontario, private health companies have been found lobbying for the privatization of some aspects of healthcare delivery. The province’s current Progressive Conservative government has a history of working with private companies to further encroach on the health sector, rather than investing in the public healthcare system. This should be of concern for Ontarians, as a BC decision for the Cambie Case plaintiffs would have given the Ontario Government leverage to continue down this privatization agenda and endanger the province’s already resource-limited healthcare services.
The ruling against the Cambie case was a win for the medicare system, however as we see in the example of Ontario the work is far from over, according to Dr. Danyaal Raza, a Toronto-based family doctor, assistant professor at the University of Toronto, and past chair of Canadian Doctors for Medicare. Not only is there concern for the push for privatization but there is also the fear that the ruling of the Cambie Case will be challenged in BC and an appeal will be made to the Supreme Court of Canada. “The decision made at this level could have national implications, particularly if the court rules in favor of the plaintiffs,” said Dr. Raza.
The public healthcare system obviously needs improvement and protection against privatization efforts. Expansion in the delivery of services and investment in system efficiencies, rather than introducing parallel private payment, will improve access for all Canadians.
Dr. Raza also shared his insights on the benefits and drawbacks of virtual care. He explains virtual care is beneficial in connecting with patients; however, there are some concerns regarding the operationalization of this type of care, in particular, if clinics deliver virtual care only.
For instance, walk-in clinics that are virtual only raise concerns about the type of services these clinics can offer, especially services that do require an in-person visit. “If the clinics can’t offer that, then patients are directed to the emergency department, which does nothing to alleviate emergency departments and creates waste. Now the patient requires two visits when one would have only been needed,” said Dr. Raza.
An evaluated mix of virtual and in-person primary care delivery is the best way to utilize this tech tool. Giving patients the option of either type of appointment would give patients the flexibility Dr. Raza explains: “Virtual care can be a powerful tool for health equity if used properly. But then it can also be a powerful tool for profit if regulations are not enforced.”
Virtual consultations such as RACE would bridge the barrier for some patients in accessing specialists, and would also help in reducing in-person wait times. The pandemic demonstrated the efficiency of some virtual care doctor appointments. It’s possible to move some healthcare online resources to ease the burden on the healthcare system, and would be a good way for patients in rural or remote communities to access health services. However, this must be a public investment in virtual care, not a private for-profit enterprise.
We must be vigilant and continue to ensure healthcare stays public. Encroachment towards privatization is not the answer, but innovation in the healthcare system can happen through public ownership that ensures access for all.
Amal Abdulrahman is a fellow of the Diversity Youth Fellowship hosted by the Urban Alliance on Race Relations, and graduate student in International Health at Johns Hopkins Bloomberg School of Public Health.
Header photo by Greg Rosenke on Unsplash