Abstract :
Choice is often touted as a means for change within health care
systems. Yet ‘choice’, in this context, takes at least three distinct forms:
choice between providers within a publicly funded health care system; choice
between competing insurers within a universal plan; and, lastly, choice as
between privately financed health care and universal public coverage. In
Canada, it is this last form of choice that is under active debate; particularly
in light of the Supreme Court of Canada’s decision in Chaoulli, which found
a regulation banning private health insurance for medically necessary care was
unconstitutional. The argument is frequently made that Canada is an outlier
from other countries in having regulation that effectively precludes this kind
of choice. This issue is likely to become of concern again in upcoming
constitutional challenges where applicants are looking to overturn through
judicial challenges Canada’s medicare system. This article tests that argument
of whether Canada truly is ‘odd’ from a comparative policy perspective by
exploring regulation of choice of privately financed health care in several
European countries – the Netherlands, Germany, Sweden, England and France.
We highlight commonalities as well as differences, showing the extent to
which these countries employ regulation to fetter growth of a large privately
financed sector. The article’s thesis is that Canada, in employing more intrusive
forms of regulation, is not an outlier per se but at one point in a regulatory
spectrum.
