Provinces should allow other options, like duplicate insurance, so patients can access the care they need more quickly

Maria Lily ShawOver 660,000 Canadians are waiting for surgery at the moment, with many waiting long months and even years.

For these people, each day stuck on a waiting list is 24 more hours of sore knees, of pain when walking, of risking that their condition deteriorates, and so on.

And we know these people: they’re our friends, our neighbours, our colleagues, and our parents.

Unless they have enough money to go abroad or have the means to pay out of pocket to go to a private clinic, waiting and waiting is their only option.

Unfortunately, it is not possible to take precautions against such an eventuality with an insurance policy, either. In Canada, if a governmental health insurance plan covers a treatment, private insurance is excluded from providing relief.

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This is not the norm for countries with universal health insurance. In the United Kingdom, Sweden, and Australia, to name just a few, a market exists for so-called duplicate health insurance that provides access to private treatment options, even if those treatments are covered by the governmental system.

The benefits of allowing private insurance policies to provide these services are two-fold:

  1. the insured avoids languishing on waiting lists waiting for governmental health care treatment, and
  2. the pressure on the public system is alleviated.

People in other countries seem satisfied with their two-tier system. In Australia, for example, almost one in two people has such a private insurance policy, which allows a sizeable share of the middle class to have access to care in the private sector when the public sector is not keeping up with the demand. The rate of satisfaction is 73.7 per cent, according to a poll conducted in 2020 among over 25,000 Australians.

In comparison, a recent poll found that 49 per cent of Canadians are dissatisfied with their provincial health care system.

While you can’t buy duplicate insurance here, it’s not because there’s no demand or market for it. It’s because it’s either prohibited outright or there’s a set of laws that makes it unfeasible for insurance companies to offer such a product.

Currently, only four provinces allow such plans to exist: Nova Scotia, New Brunswick, Saskatchewan, and Newfoundland and Labrador.

Unfortunately, these provinces likely do not have sufficiently large populations to make it worthwhile for companies to offer duplicate insurance. Saskatchewan, the largest of them, has just 1.2 million inhabitants, about as many as in the Ottawa metropolitan area if you don’t include the city of Gatineau.

To this are added restrictions on billing, and the banning of mixed practice, making it difficult for a market to develop.

Following the Chaoulli decision, Quebec authorized duplicate health insurance, but only for three very specific procedures. For all other procedures, the law formally prohibits duplicate insurance. Not surprisingly, an insurance market has not developed that would cover just total hip or knee replacement or cataract extraction with intraocular lens implantation. These procedures are too specific and too limited for a critical mass of the population to choose to insure themselves.

The five other provinces have not complicated things with exceptions, simply prohibiting the sale of such insurance completely.

The result is that the only treatment option for the vast majority of Canadians is to languish on the waiting lists that have become characteristic of our provincial health-care systems.

But as former Supreme Court Chief Justice Beverly McLachlin noted, “Access to a waiting list is not access to health care.”

For 660,000 of our fellow Canadians, the inaccessibility of care is anything but theoretical. They live it every day as they wait for their operations. It’s a safe bet that many of them would choose to be treated in the private sector, if insurance lowered the financial barriers to doing so.

After all, waiting is never fun, but it’s worse when you’re in pain.

The best thing our provincial governments could do to help is to allow other options, like duplicate insurance, so patients can better access the care they need.

Maria Lily Shaw is an Associate Researcher at the Montreal Economic Institute and the author of Spending Your Golden Years at Home: Developing Home Care Services in Quebec.

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