Wait-Time Guarantees for Health Services: An Analysis of Quebec's Reaction to the Chaoulli Supreme Court Decision‪.‬

The Quebec government's response to the Chaoulli Supreme Court decision (1) regarding unreasonable wait times and private health insurance has been to introduce guaranteed wait time limits for certain health care services. This article examines two documents: Guaranteeing Access: Meeting the Challenges of Equity, Efficiency and Quality (the White Paper), (2) and Bill 33, An Act to Amend the Act Respecting Health Services and Social Services and Other Legislative Provisions, passed and assented in December 2006. (3) An analysis of these documents shows that the government is suggesting not one but two separate guarantee mechanisms quite different from one another: a public guarantee on the one hand and a public-private guarantee on the other. The first, the public guarantee, is for all practical purposes already in place, even if not in those terms, for tertiary cardiology and radiation oncology services. Results of the use of this mechanism in the past few years have shown dramatic improvement to access to care. I welcome the expansion of the public guarantee for health care services in Quebec. However, the Quebec proposal also introduces a second type of guarantee, the public-private one, about which I express strong reservations. This guarantee is linked to staunch conservative ideology, as found in Canada and elsewhere, and it is part and parcel of the introduction of private health insurance for medical and hospital services, as well as contracting-out public services to private for-profit enterprises. Its main impact over the medium to long term will be the support of the legalization and expansion of private surgical facilities and, more broadly, the implementation of a parallel system of private medical and hospital care in Quebec. The public interest of Quebecers is poorly served by such an initiative.