Is Two-Tier Health Care the Future?

Canadians are deeply worried about wait times for health care. Entrepreneurial doctors and private clinics are bringing Charter challenges to existing laws restrictive of a two-tier system. They argue that Canada is an outlier among developed countries in limiting options to jump the queue.

This book explores whether a two-tier model is a solution.

In Is Two-Tier Health Care the Future?, leading researchers explore the public and private mix in Canada, Australia, Germany, France, and Ireland. They explain the history and complexity of interactions between public and private funding of health care and the many regulations and policies found in different countries used to both inhibit and sometimes to encourage two-tier care, such as tax breaks.

This edited collection provides critical evidence on the different approaches to regulating two-tier care across different countries and what could work in Canada.

This book is published in English.

En matière de réglementation de soins de santé à deux vitesses, quelle est l'expériences canadienne, australienne, irlandaise, française et d'ailleurs? Cet ouvrage propose des options quant aux politiques publiques à mettre en place advenant que la contestation constitutionnelle du système des soins de santé ait gain de cause.
Colleen M. Flood FRSC is a University of Ottawa Research Chair in Health Law & Policy and inaugural director of the Ottawa Centre for Health Law, Policy and Ethics.
Bryan Thomas is Senior Research Fellow with the Centre for Health Law, Policy and Ethics and Adjunct Professor with the Faculty of Law, University of Ottawa. His research spans a wide range of topics including Canadian and comparative health law and policy, health rights litigation, long-term care, global health law, and the role of religious argument in legal and political discourse.
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
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