Grant: Operating Grant

Canadian provinces legislate to prevent a two-tier health care system in accordance with the Canada Health Act. These restrictions are increasingly subject to constitutional challenge on the grounds they infringe individual rights to life, liberty and security of the person pursuant to the Canadian Charter of Rights and Freedoms. The claim is made that without the option of going private, Canadians are forced to wait long period of times in pubic queues, jeopardizing their health and even on occasion their lives. There are two major concerns if upcoming litigation is successful in introducing a two-tier system. First there is departure from the principle that access to care should be allocated on need and not ability to pay. Second is the concern that wait times for public patients will grow if doctors have an incentive to spend more time treating private-pay patients. In the wake of a successful constitutional challenge, provincial governments will need to respond quickly and must now prepare for the challenges that may arise from a parallel tier and dual practice. In this research project we explore whether provincial governments through negotiating contracts with doctors could allow a small private-pay sector for medically necessary care and ensure a strong public health care system. The UK uses contracts in an effort to ensure that its doctors spend a sufficient amount of time treating public patients and we will examine how those contracts function and the feasibility of using a similar policy tool in Canada.