© Copyright 2006 Rogers Publishing Ltd. The following article first appeared in the July 2005 edition of BENEFITS CANADA magazine.
The Chaoulli case: two-tiered healthcare?

A two-tiered healthcare system is a not-so- distant possibility for all Canadians. In the form of a court ruling, private healthcare has officially arrived in Canada and is quite possibly here to stay. The Supreme Court of Canada’s decision in Chaoulli and Zeliotis vs. Quebec—allowing Quebecers access to private healthcare through private insurance—has benefits consultants perplexed as to what this could mean for plan sponsors not only in Quebec, but also in the rest of the country.

Francois Picard, a partner in the benefits consulting practice of Morneau Sobeco in Montreal, argues that employers will need time to digest the Court’s decision, but thinks they could very well change their plans to accommodate this ruling. “With this decision, we may see some private plans start to open up,” he says. “They will start more openly to offer [coverage for] special surgeries that were only covered before by public plans.”

Joseph Ricciuti, national director of Watson Wyatt Worldwide’s group and healthcare practice in Toronto, says it is imperative Canadian plan sponsors revisit their contract wording and bargaining agreements to prepare for possible changes brought on by the ruling. “We need to get some education around consumer-driven healthcare,” says Ricciuti. “Employers will have to communicate [to members], ‘it’s a shared responsibility, and we cannot absorb the full brunt of this decision.’”

Admittedly, Ricciuti says there is much debate around the privatization of healthcare in Canada, but argues the healthcare system is currently unsustainable. “You need a new measure of funding,” he says.

With mounting healthcare costs, Picard too suggests that Canadians need to face reality, learning from other countries that have already implemented privately- funded healthcare systems. “We cannot afford to have a public plan where you don’t have to pay a cent when you want to access services,” says Picard. “If you look at other countries…Great Britain opened the door to get access to private care. Canada is really alone compared to Cuba, Northern Korea. All of those countries are not prohibiting people from getting access to private care if they want to pay for it. But, if you want to get surgery and it’s $20,000, not everybody will be able to pay.”


While the pro-privatization [lobby] has pounced on the decision as spelling the death of medicare, in fact all of the Supreme Court justices acknowledged the importance and validity of the Canada Health Act. Moreover, the legal effect of the Court’s decision is limited to Quebec.

For that reason, [the ruling] has no legal bearing on neither the Canada Health Act nor any other provincial healthcare insurance plan, including those that also ban private insurance.

This ruling may pressure the governments(at all levels)to review their positions on the time spent by patients waiting in queues. While the government of Ontario has taken action to reduce waiting times for certain selected procedures this summer, the pressure will now come from the public to reduce this waiting time for more situations. This will will have a dynamic effect on Canadian healthcare in general, including the public system. Public demand has just become more powerful.

The decision means the fundamental laws [governing health care] do not violate the Canadian Charter of Rights and Freedoms. That being the case, then the overall structure of healthcare is sound…This is not an opening of the floodgates for the destruction of Canada’s healthcare system.

The Supreme Court has provided a wakeup call to all of us, especially those of us charged with fixing our single-tier medicare program. This judgment must serve to hasten the progress of real reform. As a result of last September’s first ministers’ healthcare deal, money is no longer an excuse.

Chandra Price

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