More than 159,000 Quebecers are currently waiting for surgery. A third of them have been waiting for more than six months.
For these people, each additional day spent on a waiting list means 24 more hours of having bad knees, having pain while walking, risking their condition to deteriorate, etc.
We know these people: they are our friends, our neighbours, our colleagues and our relatives.
Waiting is their only option, unless they have enough money to go abroad or pay cash for a private clinic.
Unfortunately, this last option cannot be offered to them by an insurance policy either: in Canada, if a treatment is covered by the government health insurance plan, you will not find private insurance covering this same treatment.
Yet this is not the norm for countries that have universal insurance systems. In the UK, Sweden and Australia, to name a few examples, a market exists for so-called duplicate medical insurance, which provides access to private treatment options, even if these treatments are covered by the government system.
Double benefit
The advantage is twofold: these insurance policies allow policyholders to avoid languishing on waiting lists for their government healthcare system and reduce the pressure on the local public system. The citizens seem satisfied. In Australia, for example, almost one in two people have such a plan. This therefore allows a good part of the middle class to access another option of care in the private sector, when the public does not meet the demand. The satisfaction rate for these plans is 73.7%, according to a 2020 survey of more than 25,000 Australians. By way of comparison, a recent poll indicated that 49% of people here are dissatisfied with our health care system.
If duplicate insurance is not offered here, it is not because there is no market or demand. It’s more that a set of laws make it unattractive for an insurer to launch such a product. Currently, only four Canadian provinces allow such insurance plans to exist: Nova Scotia, New Brunswick, Saskatchewan and Newfoundland and Labrador.
What they have in common is that they probably do not have a large enough population to make it worth the cost for insurers to develop products specific to these regions. The most populous, Saskatchewan, has 1.2 million inhabitants. It is about as much as the metropolitan area of Ottawa, if we omit the city of Gatineau.
Added to this are restrictions on invoicing and the ban on mixed practice, which means that the market is struggling to develop.
In Quebec, duplicate health insurance was only authorized for three very specific interventions following the Chaoulli decision. For all other interventions, the law strictly prohibits duplicate insurance.
Not surprisingly, an insurance market has not developed for total hip or knee arthroplasty, or for cataract extraction with intraocular lens implantation. The interventions are too specific, too limited, for a critical mass of the population to choose to take out insurance. The five other provinces have not complicated their lives: they formally prohibit the sale of this insurance.
The result: for the vast majority of Canadians, the only option for care is to languish on the waiting lists that have become a hallmark of our health care system. But as former Supreme Court Chief Justice Beverly McLachlin noted, “access to a waiting list is not access to health care.”
For 159,000 of our compatriots, this inaccessibility of care is not theoretical either. They experience it daily while waiting for an operation. It’s a safe bet that many of them would opt for private treatment if insurance removed the financial barriers.
If waiting is never pleasant, it’s even worse when you’re in pain.
The best thing the Government of Quebec could do to help them would be to offer them other options, such as duplicate insurance, so that they can access the care they need.