The Political and Economic Sustainability of Health Care in Canad ...

including participation by for-profit entities in the delivery of publicly financed health care services. Privatization is also seen as a fail-safe for maintaining public access to services as provinces for various reasons reduce the scope of publicly funded services or narrow the covered populations. Examples of newer private markets include servicing workplace return-to-work and wellness programs, preemployment health checks, disability insurers other than workmen’s compensation boards, auto insurers in some provinces, and direct marketing to the public of noninsured services—such as cosmetic surgery, laser eye surgery, bariatric procedures, and preventative CT scans, as well as “enhancements” to medicare-covered procedures, such as cataract surgery. Home care (short-term) and long-term care services and settings (assisted living) are other areas in which commercial organizations have developed. This approach has resulted in increased provision and public regulation of such services—either directly through statutes and regulations or indirectly through delegated self-regulating authorities, such as colleges of physicians and surgeons. There seems to be some convergence in most provinces with respect to the increase in private, for-profit services, although the nature of such increases in the purchase of care and provision of capital differs from province to province. The following section provides some general discussion of these developments and of the tension between some such developments and the mandates of the Canada Health Act.

An issue driving reform is the difficulty in maintaining equal access to new and expensive medical technology (Fierlbeck 2001; Palley, Pomey, and Forest 2011). There have been increasing calls to introduce privatization into the health care delivery system in provinces as diverse as Alberta, Ontario, and Quebec in order to facilitate access to high-end treatments or imagery equipment (D. Adams 2001; Church and Smith 2006; Grey 1991, 1998). Establishing a private system independent of the public health system may first appear as a pretext for catering to more affluent groups with the ability to pay additional charges for such services. But in reality, things are much more complex, and some clarification regarding the terms of the debate is required.