Alberta's move to allow doctors to work in both public and private health care does not violate the Canada Health Act, according to the Montreal Economic Institute, which says similar mixed-practice models are already permitted in four other provinces.The MEI said restrictions on doctors working in both systems generally stem from provincial legislation and administrative rules rather than federal law.“Mixed practice has not developed everywhere that it is permitted, for a number of reasons, but it is important to remember that there are already four provinces that authorize it,” said MEI vice-president of communications Renaud Brossard.“Indeed, it is not so much the Canada Health Act that obstructs its development and deployment, but rather a series of provincial laws and administrative practices.”Alberta adopted the Health Statutes Amendment Act last fall, allowing physicians to work in both the public and private systems while requiring them to provide a minimum number of hours in the public system.The MEI said Manitoba, Nova Scotia, Prince Edward Island and Newfoundland and Labrador already permit mixed practice. Political parties in Quebec have also discussed adopting the model.“What the Canada Health Act circumscribes is much more limited than certain defenders of the status quo like to claim,” said Brossard.“Unfortunately, over time, too many people have tried to make this law mean anything and everything.”The think tank based its position in part on a legal opinion from Trudel & Johnson, a law firm that co-represented George Zeliotis in the landmark Chaoulli v. Quebec case.The MEI published an Economic Note in 2003 arguing that mixed practice complies with the Canada Health Act provided privately delivered services are not publicly insured and are paid entirely by patients or private insurers..Under that interpretation, provinces can continue providing insured services without charge through the public system while allowing doctors to separately provide privately funded services.The MEI said provinces would remain eligible for full federal health funding as long as publicly insured services remain universally available and fully financed.The Canada Health Act's universality provision requires provincial health insurance plans to entitle 100% of insured residents to covered health services on uniform terms and conditions.The MEI said the relevant provisions of the federal legislation have remained essentially unchanged for more than two decades.“People are reading into Canadian law prohibitions that do not exist,” said Brossard.“It is the combining of public and private funding that the law essentially aims to prevent, which would for instance allow patients to pay to get publicly funded care more quickly.”Brossard said the federal law addresses issues including extra billing and user charges rather than whether an individual physician can practise in both systems.The MEI also pointed to international health systems where doctors are permitted to work in both public and private settings.According to Commonwealth Fund data cited by the organization, Canada ranked seventh among 11 comparable countries for health-care system performance. Australia, the Netherlands, United Kingdom, New Zealand, France and Sweden ranked ahead of Canada, and the MEI said none prohibits mixed practice.The organization also cited a Danish study that found no statistically significant difference in the number of public-system hours worked by mixed-practice physicians compared with doctors working exclusively in the public system.Doctors participating in mixed practice provided an average additional 5.2 hours of work each week in private health-care facilities, according to the study.“Instead of resorting to scare tactics, Ottawa should ask itself why Canadian health care struggles so much to meet patients’ needs,” said Brossard.“Mixed practice is in full compliance with the Canada Health Act, and would help provide more care, more quickly, to more patients.”
