Duplicative insurance models where clients can purchase private insurance to access medically necessary services already covered under the Canada Health Act, should continue to be prohibited or severely restricted in Canada, according to a new draft policy paper published by the Canadian Medical Association (CMA).
The policy, intended to help guide the CMA’s advocacy efforts, focuses heavily on equity and on managing Canada’s public-private healthcare balance.
“At its heart, this proposal strongly supports a publicly funded health care system where access to medically necessary care is based on patient needs and not on their ability to pay. At the same time, it responds to the reality of our current access to care crisis and the many funding and delivery proposals already implemented or being considered across the country,” the CMA writes in a statement about the draft policy’s release. “While various viewpoints were expressed on the issues, national consensus emerged that our health care system should not favour those who can afford to pay for services. Equity remains a bedrock value that is shared by all – physicians, patients and the public.”
Mentioning private insurers directly only minimally, the draft CMA policy, entitled Managing the Public-Private Interface to Support Quality Care, discusses growing disparities for patients from different provinces and territories, discusses private health care options, wait times and barriers to care.
They observe that a variety of private health care options, including virtual care, are emerging in different parts of the country. Later, the paper examines what happens when patients cannot access timely care: “One proposed solution previously identified is to permit private insurance for medically necessary services,” they write. They add that available evidence, however, “has shown the introduction of private, duplicative health insurance, while beneficial for those who can afford it, creates significant inequalities to access health care, draws resources away from the public system and leads to higher overall health spending.”
The CMA’s recommendations include severely restricting duplicative insurance models. They conclude, calling for more research and by saying particular attention should be given to areas seeing significant growth, including virtual care services and privately funded primary care clinics.
The CMA says it plans to refine the recommendations based on feedback, with the goal of finalizing the policy by Fall 2024. “These policy recommendations will form the basis of CMA’s advocacy to address the current challenges in accessing health care.”
