Healthcare Quarterly Vol.10 No.4 2007 89฀ www.longwoods.com Volume฀5,฀Number฀3฀•฀2007 Longwoods฀Review Background Since the passage of the Canada Health Act in 1984 and its prohibition of extra-billing, there has been an extremely limited role for private health insurance in Canada as a mechanism to pay for medically necessary physician or hospital services (Deber 2003; Detsky and Naylor 2003; Flood and Archibald 2001; Naylor 1999). In the aftermath of the landmark Supreme Court decision Chaoulli v. Québec (Chaoulli v. Québec [Attorney General] 2005), this may change. In Chaoulli , the Supreme Court narrowly struck down provisions under Quebec law that prohibited the purchase of private health insurance for government-insured physi- cian and hospital services (Dickens 2005). In the context of unreasonably long waiting lists, four of seven judges agreed that the ban on private insurance was unjustifiable given the rights afforded residents of Quebec by the provincial Charter of Human Rights and Freedoms. The Quebec government was granted a one-year stay of the Supreme Court ruling in order to consider its options. After a lengthy internal review, the provincial government published a consultation document in February 2006 titled Guaranteeing Access: Meeting the Challenges of Equity, Efficiency and Quality (Government of Quebec 2006), and then follow- ing public hearings, the Quebec government passed a law (Bill 33, entitled An Act to amend the Act respecting health services and social services and other legislative provisions) allow- ing residents of Quebec to purchase private health insurance to obtain certain types of care at “a specialized medical centre where only physicians not participating in the health insur- ance plan practise.” Insurance contracts for these operations would have to include coverage for necessary preoperative, post-operative and rehabilitation care, and the operations themselves are currently limited to hip and knee replace- ments as well as cataract removal. Controversially, this short list of surgeries could be expanded by regulation (i.e., without the approval of the full Quebec legislative assembly). Whether insurers offer products only for joint replacements and/or cataract surgery remains to be seen. Despite the Supreme Court’s application of the Chaoulli decision to Quebec only, the Alberta government announced early in 2006 that it too planned to introduce a system of private health insurance. The government’s proposal proved highly controversial, however, and several months later the Alberta health minister announced that the government had decided that it was “not prepared to proceed with private insurance at this time” (CBC News 2006). Partly in response to the Chaoulli decision, the Canadian Medical Association (CMA) also prepared a thoughtful and thoroughly researched report (CMA Task Force on the Public- Private Interface 2006). Canadian physicians have long been divided on the issue of private funding for medically neces- sary services, and the CMA’s report is unlikely to unify the profession. Some physician leaders have expressed support for an increased role for private health insurance in Canada (Ouellet 2005), while others have recommended a recom- mitment to the principles of single-tier healthcare (Bhatia and Natsheh 2005; Hoyt 2005). In its report, the CMA presented four scenarios for how healthcare funding and delivery could be organized in Canada, each with a different mix of public Private Health Insurance: An International Overview and Considerations for Canada Irfan Dhalla Healthcare Quarterly Vol.10 No.4 2007 89฀