Restricting private-sector practice using contracts

Flood, Colleen M.; Allen, Pauline; Thomas, Bryan; Walker, Kathryn

doi:10.1503/cmaj.140837

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…The incentive here is that young, healthy individuals may realize savings by buying private insurance in lieu of contributing income-adjusted premiums to the social health insurance scheme. Our research suggests that there are equity concerns in Germany’s system, with private patients receiving faster access to specialist appointments (Frisina and Schmid, 2016). But the larger point is that the German model of substitutive private insurance is not under debate in the Canadian context – those agitating for a greater role for the private sector in Canada are very clear that they want patients to be covered by public insurance and then to use parallel private finance (insurance or out-of-pocket payments) in order to jump public queues (or in their parlance to utilize a ‘safety valve’) (Cambie Surgeries et al ., 2016).…”

Section: How Other Countries Regulate the Public–private Dividementioning

confidence: 97%

“…England for example has little by way of traditional regulation of private care, but maintains a comparatively small private sector, comprising only 16% of total health care spending compared with an OECD average of 28% (OECD, 2014), with only 10.6% of the population holding parallel private coverage (LaingBuisson, 2017). 4 While specialists working for the NHS are technically permitted to engage in dual practice, most are salaried and contractually bound to a full-time work schedule, limiting their ability to moonlight in the private sector (Flood et al, 2015). As one might imagine, this is a major bone of contention, with contract negotiations between the government and the British Medical Association routinely breaking down over the issue of public-private work hours (The Guardiant, 2004).…”

Section: Contractual Measures To Limit Inequities From Parallel Privamentioning

confidence: 99%

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A successful Charter challenge to medicare? Policy options for Canadian provincial governments

Flood

Thomas

2018

HEPL

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In September 2016, a case went to trial in British Columbia that seeks to test the constitutionality of provincial laws that (1) ban private health insurance for medically necessary hospital and physician services; (2) ban extra-billing (physicians cannot charge patients more than the public tariff); and (3) require physicians to work solely for the public system or 'opt-out' and practice privately. All provinces have similar laws that have been passed to meet the requirements of federal legislation, the Canada Health Act (and thus qualify for federal funds). Consequently, a finding of unconstitutionality of one or more of these laws could have a very significant impact on the future of Canada's single-payer system ('medicare'). However, should the court find that a particular law is not in compliance with the Canadian Charter of Rights and Freedoms, the baton is then passed back to the government which may respond with other laws or policies that they believe to be constitutionally compliant. The ultimate impact of any successful Charter challenge to laws protecting medicare from privatization will thus significantly depend on how Canadian governments respond. Provincial governments could allow privatization to undercut equity and access, or they could respond creatively with new legal and policy solutions to both improve equity and access and tackle some of the problems that have long bedeviled Canadian medicare. This paper provides an understanding - grounded in comparative health systems evidence - of law and policy options available to Canadian lawmakers for limiting two-tier care in the wake of any successful challenge to existing laws. The paper presents the results of a large inter-disciplinary, comparative study, started in 2015, that systematically reviewed the legal and broader regulatory schemes used to regulate the public/private divide in 15 Organization for Economic Co-Operation and Development countries with a particular eye to what the effect of such regulations would be upon wait times.

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Section: How Other Countries Regulate the Public–private Dividementioning

confidence: 97%

Section: Contractual Measures To Limit Inequities From Parallel Privamentioning

confidence: 99%

A successful Charter challenge to medicare? Policy options for Canadian provincial governments

Flood

Thomas

2018

HEPL

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“…Interestingly, the characteristic of DPH is viewed as one of the better option to facilitate the regulation of dual practice as it could be more easily controlled and governed [ 5 , 6 , 13 , 27 ]. To allay the concerns about conflicts of interest and competing priorities, some countries set a maximum amount of specialists’ earnings from DPH [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Specialists’ Dual Practice within Public Hospital Setting: Evidence from Malaysia

et al. 2022

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In line with the commitment of the Malaysian government and Ministry of Health to prevent the brain drain of specialists from public hospitals, they have been permitted to perform dual practice within the public hospital setting (DPH) since 2007. DPH allowed them to hold jobs in both public and private practices within the same public hospitals that they are affiliated to, permitting these specialists to treat public and private patients. Nevertheless, the information regarding DPH in Southeast Asia region is still limited. This narrative review provides insight into the implementation of DPH in Malaysia. It highlights that DPH has been well-governed and regulated by the MOH while serving as a means to retain specialists in the public healthcare system by providing them with opportunities to obtain additional income. Such a policy has also reduced the financial burden of the government in subsidizing healthcare. However, as in other countries with similar policies, multiple challenges have arisen from the implementation of DPH in Malaysia despite its positive achievements and potentials. This paper concludes that proactive governance, monitoring, and regulation are key to ensure the success of DPH.

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Canada’s Confounding Experience with Health Rights Litigation and the Search for a Silver Lining

Colleen¹,

S²,

span³

et al. 2019

The Future of Economic and Social Rights

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Restricting private-sector practice using contracts

Cited by 4 publications

References 11 publications

A successful Charter challenge to medicare? Policy options for Canadian provincial governments

A successful Charter challenge to medicare? Policy options for Canadian provincial governments

Specialists’ Dual Practice within Public Hospital Setting: Evidence from Malaysia

Canada’s Confounding Experience with Health Rights Litigation and the Search for a Silver Lining

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