Why Two-Tier Systems Put Canadian Health Care at Risk

There are concerns among public health supports and patients that privatization of health care will expand in Ontario under Doug Ford’s government. Ford became the Premier of Ontario in June after a contentious election campaign. Canada currently has a public health care system. It’s not perfect, but it works. Deviating from it would be a great loss, especially when it comes to the public health strides Canada has made. 

The Canadian health care system has not always been public. The Canada Health Act of 1984 established federal legislation for publicly-funded health care.

The legislation itself operates on five principles: public administration, accessibility, universality, portability, and comprehensiveness. The privatization of health care would arguably contradict the accessibility and universality components of this legislation, as people’s finances and income level could be a barrier in their access to care.

Ford is allegedly considering allowing more private clinics to open in Ontario in an attempt to minimize government spending. Ford appointed former British Columbia premier Gordon Campbell to look into Ontario’s finances, including health care.

According to Toronto Star columnist Bob Hepburn, based on Campbell’s track record of advocating for private clinics and being a strong proponent of a two-tier system in B.C., people in Ontario could risk losing access to public healthcare.

“What Campbell and others like him ignore is that allowing the wealthy to buy their way to the top of the queue with cash or private insurance leaves a dwindling amount of capacity for publicly funded services because there’s only so much capacity in the system,” Hepburn wrote. “In almost every country with two-tier medicine, there’s a two-tier waiting list linked to the ability to pay, not the need for care.”

Quebec is another province that has implemented a two-tier system and had a rise in private clinics. In May 2016, public health care groups and patients tried to hold Quebec accountable for its changing healthcare by taking legal action. The groups alleged that Bill 20 implemented a two-tier system that violates the Canadian Health Act. Any legal outcomes of their allegations have not been made public.

Governmental officials have raised concerns about two-tiered health care in Quebec as far back as 2012. Then-Quebec health minister Rejean Hebert was concerned about the issue, according to CTV Montreal, a local broadcasting station.

“There is a problem with two-tier health care in Quebec,” Hebert told reporters.

The ruling in the 2006 Chaouli v. Quebec (Attorney General) case helped shape Quebec’s current system. While the Canadian Supreme Court’s decision did not inherently promote a two-tier system and private health care, it did make it legal. Similar legal cases in Ontario and British Columbia have yet to occur.

Quebec health care was not perfect before the Choali decision. Dr. Alan Davidson, a professor of Health Studies at the University of British Columbia, noted in a report for  Healthcare Policy that the public’s perception of increased wait times and quality of care played a major role in some Quebec residents wanting privatized health care.

Since the 2006 decision, there have been valid concerns that Quebec health care has worsened. This can be seen by the state of emergency rooms in Quebec, which have the longest wait times in Canada and among the longest in the Western World, according to the Montreal Gazette.  The same article reports that one in 10 ER patients leave before getting medical care. Those who stay have an average wait time of eight hours. These lengthy wait times can have a detrimental effect on the quality of care a patient in Quebec receives. I know, because I lived there for a year and a half, and had to leave. 

I started my undergraduate degree at McGill University in Sept 2016. I had no major chronic illness issues up to this point, although I had experience balancing school work with a disability, specifically hearing loss. I thought that I was finding my vibe, as I had gotten involved in many extracurricular activities and made friends that I can still count on today.

Then midterms hit.

I had just completed a long day of classes and had two meetings for extracurricular activities. I got back to my room and looked in the mirror: Hives started to appear on my face and my lips were swollen. This was new territory for me, as the only times that I had hives before was when I had been exposed to poison ivy. I messaged my parents about it, they said it was probably no big deal and to go to the emergency room the next morning.

As I didn’t qualify for Quebec insurance, I had registered for McGill University Health Centre’s International Student insurance. This, unfortunately, meant that I was pretty limited in the number of hospitals that I could go to. Wanting to save money, I took the bus.

I was triaged fairly quickly, which greatly contrasted the 10-plus hour wait times I had faced previously during my time at McGill University. A minute or two after I got to my hospital bed, which was in a shared room with about twenty people, I couldn’t breathe.

Nurses rushed to give me an EpiPen injection and put me on oxygen. While the hives had made me nervous, I was now officially terrified. I lost my ability to eat, which made me frustrated, as I normally use food as a coping mechanism when I am stressed. Over the next week, I had received test after test, and doctors said they had no idea what I had.

On my last day, I saw two allergists who told me that I was “young” and what made me sick was probably just “stress.” I asked if I could get a second opinion and was given zero follow-up information.

This started a terrible year of being incredibly sick and not knowing what was “wrong with me.” When I had episodes where I could not breathe, doctors put me on oxygen. But when I asked to be seen for further evaluation with a rheumatologist, I was told that I had to wait. During my last emergency room visit before I left Quebec due to the dismal health care I received, a doctor accused me of being a hypochondriac looking for drugs and told me my symptoms were all in my head.

While this greatly impacted my physical health, being dismissed again and again made me develop suicidal ideations that continued even after I finally got my diagnosis. One of the worst parts of searching for a diagnosis was feeling like my life was not worth it.

I left Quebec in December 2017 and went on vacation to Mexico. Unlike in Quebec, the doctors at the hospital in Mexico where I stayed actively searched for what was wrong with me. A biopsy and blood test confirmed that I had urticarial vasculitis with systemic inflammation, which explained the symptoms that I had for over a year. None of them were in my head.

Everyone deserves access to health care, no matter who they are. People in Ontario deserve better than having a two-tier health care system like Quebec.