Bioethics Blogs

“European” health care not a “fix” for Canada

Colleen M. Flood and Bryan Thomas discuss the current legal challenge before the BC Supreme Court about whether public medicare violates the Charter by forcing patients onto long wait lists.


The plaintiffs in the hearings that have begun at the BC Supreme Court – led by Dr. Brian Day of Cambie Surgery Centre (a private clinic in Vancouver) – want the court to overturn three laws: the law that stops the sale of private health insurance for medically necessary care; the law against dual practice that prohibits physicians from working in both the public system and the private sector; and the law against extra-billing so that physicians can charge whatever they wish for the care they provide, whether in public hospitals or in private clinics.

Those involved in the Cambie legal challenge argue that many western “European” health care systems have ‘two-tier’ health systems that are the envy of the world. If only Canada would allow greater private payment, they say, the invisible hand of the market would lead us to join their ranks.

Unfortunately, it’s not that simple.

For a start “Europe” is not one model of health care financing, but a variety of significantly different models.  Proponents of Canada adopting a “European” model never tell us if it’s the French, Irish, English, Dutch, German, or Italian model we are meant to be following. Moreover, while Canada is somewhat unique in its approach to enacting laws that restrict private payment, these other countries limit private payment by other means.

In England, for example, instead of fee-for-service, specialists working in the public system are salaried and contractually bound to a full-time forty-hour work schedule.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.