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Two-tier health care
Two-tier health care is a form of national
health care system that is used in most developed countries.
It is a system in which a guaranteed public health care system
exists, but where a private system operates in parallel. The
private system has the benefit of shorter waiting times and
more luxurious treatment, but costs far more than the public
one for patients. Thus there are two tiers of health care, one
for the public at large and another for those who are wealthy
enough to pay for better care.
The term is most often used in Canadian health
discussions where the debate over two-tier health care has long
been central. Moving to a two tier system is supported by conservative
think tanks such as the Fraser Institute. The potential for
vast profits has created a strong lobby in the health industry,
which is today confined to the periphery. As it stands now,
Canada does not have a parallel system, free market health care
for Canadians being almost wholly banned in fields covered by
the national health system; some private clinics and hospitals
which were operating when the national health care plan was
instituted (for example, the Shouldice Hospital in Thornhill,
Ontario) continue to operate, although they may not bill additional
charges for medical procedures. Private health care may also
be supplied in uncovered fields and to foreigners.
The phrase is also sometimes used in other
countries and among health care experts. In Europe it often
has the same meaning as in the Canadian context, but is used
there to describe the status quo. However, sometimes it has
a somewhat different meaning relating to the expansion of private
sector involvement through voucher programs or other initiatives.
The proponents of two-tier system argue that
it would introduce more flexibility into the system, reducing
wait lists and that competition from the private sector would
make the public one more efficient. Opponents argue that a two-tier
system would tend to draw many of the best doctors out of the
public system, reducing the overall level of care. The Canada
Health Act is also committed not only access to health care
to all, but access to the best health care available for all.
Many on the left consider access to the best possible care an
important right of all citizens. Competition from the private
sector would also almost certainly drive up the wages of doctors
and other medical professionals in the entire system. Those
who support a wholly public system also say that there is some
concern that if Canada would allow a parallel private system
within the country, it would be opening itself up to trade sanctions
under some of its trading agreements.
It should be noted that all advanced countries
in the world have two-tier primary health care to varying degrees
except for Canada outside Quebec where officially but not in
practice it is illegal. Many two-tier systems do attempt to
resolve these difficulties. Australia, for instance, requires
all doctors to work some of their time in the public system.
However, if care is not superior in the private system no one
would use it so a certain imbalance between the care received
by the rich and the poor exists in all two-tier systems.
The Canadian people are largely opposed to
the notion of two-tier health care, and no major political parties
support the notion. In the 2000 Canadian election the Liberals
and NDP accused the Canadian Alliance of secretly supporting
it, leading to a famous incident when in the leaders debate
Canadian Alliance leader Stockwell Day began waving a hand written
"No Two-Tier Medicine" sign. Some argue that Canada
already does have a two-tier health care system as the very
wealthy can go to the United States for treatment, and quite
a few Canadians do each year. Some provinces have increasingly
allowed the private sector to provide medical services for a
fee. Quebec has especially allowed the private sector to provide
enhanced medical services to the public for a fee.