Cet ouvrage fait l'analyse des experiencescanadienne, australienne, irlandaise, francaise et d'ailleurs en matiere de reglementationde soins de sante a deux vitesses afin d'en tirer des options en matiere depolitiques publiques qui pourraient etre mises en place advenant que lacontestation constitutionnelle actuelle du systeme des soins de sante ait gainde cause. Le Canada fait souvent bande a partdans la mesure ou il limite severement l'injection de fonds prives dans lesservices publics de soins de sante. Or, une contestation constitutionnelle deslois qui protegent ces services publics est presentement en cours. Si lescliniques privees et les medecins reussissent a avoir gain de cause et a faire abolirles lois qui protegent ces services publics, les decideurs auront tres peu detemps pour elaborer de nouvelles lois et politiques qui protegeront le systemecanadien d'une privatisation poussee.
Les collaborateurs a ce volume sontexperts en droit, en economie, en histoire, en medecine, en sociologie, enscience politique et en politique publique. Une analyse qui fait appel a cesdisciplines permettrait de mieux determiner la meilleure facon de reglementer unsysteme de soins a deux vitesses. Parmi les sujets abordes, nommonsl'histoire du financement prive des soins de sante canadiens, une analyse desdefis historiques et de la contestation constitutionnelle actuelle auxquelssont confrontes les soins de sante, l'analyse de la reglementation des systemesa deux vitesse en Australie, en Irlande et en France, et les lecons retenuespour le Canada, le modele economique d'un systeme de financement parallele, lesliens entre l'inegalite croissante et la demande accrue pour des assurancesprivees, les questions ethiques liees au resquillage, les soins a domicile adeux vitesse au Canada, l'autoreglementation en tant que moyen de reglementerles soins a deux vitesse, l'utilisation de contrats de medecins pour limiterles soins a deux vitesse, et la synthese des options juridiques et en matierede politiques publiques pour reglementer les soins a deux vitesses au Canada. Lesthematiques reprises tout au long des chapitres multidisciplinaires sontpresentees dans l'introduction puis ramenees en conclusion pour offrir unecomprehension approfondie des enjeux de ce grand debat sur l'avenir des soinsde sante. Ce livre est publie en anglais. --Canadians are deeply worried about wait times for health and this book explores whether or not two-tier health care is a solution.
Entrepreneurial doctors and private clinics are bringing Charter challenges to existing laws restrictive of a two-tier system. They argue (wrongly in our view) that Canada is an outlier amongst developed countries in limiting options to jump the queue. In this book, leading researchers explore the public and private mix in Canada and within countries such as Australia, Germany, France and Ireland. We explain the history and complexity of interactions between public and private funding of health care. We also explain the many regulations and policies found in different countries used to both inhibit and sometimes to encourage two-tier care (for example, tax breaks). If a Canadian court strikes down laws restrictive of two-tier, Canadian governments can (i) permit and even encourage two-tier care to grow; (ii) pass new regulations that allow a small measure of two-tier care; or (iii) take positive steps to eliminate wait times in Canadian health care, and thereby reduce demand for two-tier care. We argue for option three as the best means to ensure Canadian principles of equity in access, ensure timely care, and fend off constitutional challenges.
This work is critical not only for court challenges but also for Canadian governments who need the best evidence possible about different approaches to regulating two-tier care if they are forced by a court to revisit existing laws as a result of a successful Charter challenge.
This book is published in English.
List of Figures List of Tables Introduction The Courts and Two-Tier Medicare Colleen M. Flood and Bryan Thomas Part I: The Context and Contestations of Public and Private in the Canadian Health Care System 1. Private Finance and Canadian Medicare: Learning from History Gregory P. Marchildon 2. Chaoulli to Cambie: Charter Challenges to the Regulation of Private Care Martha Jackman 3. Borders, Fences, and Crossings: Regulating Parallel Private Finance in Health Care Jeremiah Hurley 4. Chaoulli v Quebec: Cause or Symptom of Quebec Health System Privatization? Amélie Quesnel-Vallée, Rachel McKay, and Noushon Farmanara 5. Experiences with Two-Tier Home Care in Canada: A Focus on Inequalities in Home Care Use by Income in Ontario Sara Allin, David Rudoler, Danielle Dawson, and Jonathan Mullen 6. Self-Regulation as a Means of Regulating Privately Financed Medicare: What Can We Learn from the Fertility Sector? Vanessa Gruben Part II: Is Canada Odd? Looking at the Regulation of Public/Private Mix of Health Care in Other Countries 7. The Politics of Market-Oriented Reforms: Lessons from the United Kingdom, the United States, and the Netherlands Carolyn Hughes Tuohy 8. The Public-Private Mix in Health Care: Reflections on the Interplay between Social and Private Insurance in Germany Achim Schmid and Lorraine Frisina Doetter 9. The Public-Private Mix in France: A Case for Two-Tier Health Care? Zeynep Or and Aurélie Pierre 10. Embracing Private Finance and Private Provision: The Australian System Fiona McDonald and Stephen Duckett 11. Embracing and Disentangling from Private Finance: The Irish System Stephen Thomas, Sarah Barry, Bridget Johnston, Rikke Siersbaek, and Sara Burke 12. Contracting Our Way Around Two-Tier Care? The Use of Physician Contracts to Limit Dual Practice Bryan Thomas Conclusion The Complex Dynamics of Canadian Medicare and the Constitution Colleen M. Flood and Bryan Thomas Contributors’ Biographies Acknowlegments Index
Vanessa Gruben B.Sc.H (Queen's), LL.B. (Ottawa), LL.M. (Columbia) is Vice Dean (Academic), an Associate Professor at the University of Ottawa, Faculty of Common Law and a member of the Centre for Health Law, Policy and Ethics. She also leads the Ottawa Hub for Harm Reduction a multidisciplinary forum for scholars and community organizations who work on innovative harm reduction strategies. She is also co-editor of the 5th edition of Canada's leading text on health law and policy in Canada, Canadian Health Law and Policy, co-edited with Joanna Erdman and Erin Nelson (LexisNexis, 2017). Professor Gruben teaches graduate and undergraduate courses in Health Law and a seminar on Access to Health Care.
Reviews for Is Two-Tier Health Care the Future?
Is Two-Tier Health Care the Future?, is the best book in years about the past, present and future of Canadian Medicare. The book, with its compelling introduction by Colleen Flood and Bryan Thomas, is well written and well edited. Unlike many edited volumes, authors have written coherent, linked, chapters on the most controversial topics in Canadian medical care. These prominently include the history of intense disputes over private and public finance of hospitals and physicians, and address how and why private finance of Canadian medical care has always been and will continue to be so controversial. The most unusual feature of Canadian health care policy—illuminated by chapters on medical finance in other rich democracies—is how judicial decision making in Medicare’s past and present has become dominated by constitutional law and disputes about how much market allocation is tolerable in an egalitarian program like Canada’s Medicare. How that came to be over the past few decades and what the BC Cambie Clinic case means for the future is what this serious work of scholarship provides. -- Theodore R. Marmor The Canadian health care system is a source of our collective pride, but it is also in serious need of improvement. So often privatization is put forward as a solution to our challenges, with little regard for the evidence. This excellent collection offers evidence and analysis from some of our greatest thinkers on a wide variety of issues relating to 2-tier health care. A must-read for those who care about protecting and enhancing the national treasure that is Canadian Medicare. Danielle Martin, MD
