Excerpt

“….overcoming the many barriers
and interest groups opposed to universal medicare was a hard-won political war
waged over many years, particularly with respect to medical associations who
fought tooth and nail against the prospect of a public health care system and
various politicians who were ideologically in favour of maintaining a significant
role for private health insurance.  The
melange of laws that exist across the provinces, and the Canada Health Act
itself, are thus a product of the particular history and context of medicare,
including political accommodations necessary to bring doctors into the public
plan (for example, they are not public employees but independent contractors
mostly paid on a fee-for-service basis with still relatively little
governmental control over their clinical decision-making).”

Table of contents

List of Figures

List of Tables

Introduction
The Courts and Two-Tier Medicare
Colleen M. Flood and Bryan Thomas

Part I: The Context and Contestations of Public and Private in the Canadian Health Care System

1. Private Finance and Canadian Medicare: Learning from History
Gregory P. Marchildon

2. Chaoulli to Cambie: Charter Challenges to the Regulation of Private Care
Martha Jackman

3. Borders, Fences, and Crossings: Regulating Parallel Private Finance in Health Care
Jeremiah Hurley

4. Chaoulli v Quebec: Cause or Symptom of Quebec Health System Privatization?
Amélie Quesnel-Vallée, Rachel McKay, and Noushon Farmanara

5. Experiences with Two-Tier Home Care in Canada: A Focus on Inequalities in Home Care Use by Income in Ontario
Sara Allin, David Rudoler, Danielle Dawson, and Jonathan Mullen

6. Self-Regulation as a Means of Regulating Privately Financed Medicare: What Can We Learn from the Fertility Sector?
Vanessa Gruben

Part II: Is Canada Odd? Looking at the Regulation of Public/Private Mix of Health Care in Other Countries

7. The Politics of Market-Oriented Reforms: Lessons from the United Kingdom, the United States, and the Netherlands
Carolyn Hughes Tuohy

8. The Public-Private Mix in Health Care: Reflections on the Interplay between Social and Private Insurance in Germany
Achim Schmid and Lorraine Frisina Doetter

9. The Public-Private Mix in France: A Case for Two-Tier Health Care?
Zeynep Or and Aurélie Pierre

10. Embracing Private Finance and Private Provision: The Australian System
Fiona McDonald and Stephen Duckett

11. Embracing and Disentangling from Private Finance: The Irish System
Stephen Thomas, Sarah Barry, Bridget Johnston, Rikke Siersbaek, and Sara Burke

12. Contracting Our Way Around Two-Tier Care? The Use of Physician Contracts to Limit Dual Practice
Bryan Thomas

Conclusion
The Complex Dynamics of Canadian Medicare and the Constitution
Colleen M. Flood and Bryan Thomas

Contributors’ Biographies
Acknowlegments
Index

Description

Canadians are deeply worried about wait times for health care. Entrepreneurial doctors and private clinics are bringing Charter challenges to existing laws restrictive of a two-tier system. They argue that Canada is an outlier among developed countries in limiting options to jump the queue. 

This book explores whether a two-tier model is a solution. 

In Is Two-Tier Health Care the Future?, leading researchers explore the public and private mix in Canada, Australia, Germany, France, and Ireland. They explain the history and complexity of interactions between public and private funding of health care and the many regulations and policies found in different countries used to both inhibit and sometimes to encourage two-tier care, such as tax breaks. 

This edited collection provides critical evidence on the different approaches to regulating two-tier care across different countries and what could work in Canada. 

This book is published in English. 

 

Reviews

Is Two-Tier Health Care the Future?, is the best book in years about the past, present and future of Canadian Medicare. The book, with its compelling introduction by Colleen Flood and Bryan Thomas, is well written and well edited. Unlike many edited volumes, authors have written coherent, linked, chapters on the most controversial topics in Canadian medical care. These prominently include the history of intense disputes over private and public finance of hospitals and physicians, and address how and why private finance of Canadian medical care has always been and will continue to be so controversial. The most unusual feature of Canadian health care policy—illuminated by chapters on medical finance in other rich democracies—is how judicial decision making in Medicare’s past and present has become dominated by constitutional law and disputes about how much market allocation is tolerable in an egalitarian program like Canada’s Medicare. How that came to be over the past few decades and what the BC Cambie Clinic case means for the future is what this serious work of scholarship provides.

- Theodore R. Marmor

The Canadian health care system is a source of our collective pride, but it is also in serious need of improvement. So often privatization is put forward as a solution to our challenges, with little regard for the evidence. This excellent collection offers evidence and analysis from some of our greatest thinkers on a wide variety of issues relating to 2-tier health care. A must-read for those who care about protecting and enhancing the national treasure that is Canadian Medicare.

 

Danielle Martin, MD