What does the Supreme Court decision mean for Saskatchewan health care?

Last week the Supreme Court of Canada decided not to hear a B.C. doctor’s appeal on expanding access to health care.

The decision leaves privately-funded health care prohibited in the province and effectively settles that element of the private-versus-public-funding debate on the west coast.

But it comes as other provinces continue to push ahead with privately-funded health care — even though it violates the Canada Health Act and will likely mean the provinces receive less federal funding.

Saskatchewan patients who need an MRI or CT scan can bypass waitlists by paying for themselves at private clinics, so long as the clinic then scans someone on the public waitlist at no cost to the second patient.

It’s part of the province’s plan to reduce surgery wait times, which ballooned during the COVID-19 pandemic.

(Saskatchewan’s finance minister Donna Harpauer said previously that more than $40 million in this year’s budget will help clear the pandemic buildup a year ahead of schedule.)

But a family physician told Global News that system rewards the wealthy and preys upon people’s fears when facing a medical issue.

“I don’t think it’s fair to allow people that have the means to jump ahead of those who don’t have the means,” Dr. Adam Ogieglo said.

He said the measure hasn’t lowered the wait times.

A Saskatchewan government website shows the average wait for CT scans grew from 33.5 days waited in January 2016, the year the government started using private clinics, to 40.6 last December. Days waited for MRI scans rose from 40.6 to 81.2 over that same period.

Lorian Hardcastle, a professor at the University of Calgary’s law school and medical school, said any element of privatization challenges the underpinning assumption that health services are based on need.

But she said the Supreme Court’s decision is not binding on other provinces.

And while allowing individuals to pay for publicly-insured services violates the Canada Health Act, Hardcastle said the legislation is not as binding as many Canadians think.

“It really is just a funding arrangement between the two levels of government,” she said, adding that the federal government can’t legislate how provinces use the money since health care is a provincial issue.

“The main mechanism of enforcement under the Canada Health Act is the (federal government) withholding money. And so if provinces are content to take a reduced transfer payments in order to allow private payments, then there isn’t a lot that can be done.”

In March, federal health minister Jean-Yves Duclos announced Ottawa would recoup $82 million from provinces that charged patients for services that should have been covered by public money.

Duclos’ Regina counterpart, Paul Merriman, said the lost money amounted to around $750,000.

He also said Saskatchewan would continue to “support patient choice” and that the province’s medical imaging has benefited patients and the public health care system.

A loss of less than a million dollars doesn’t amount to much when the overall health care budget for 2023-24 is just shy of $7 billion.

Hardcastle said the courts have determined individuals can’t sue provincial governments over violations of the Act, essentially making adherence to it an election issue.

Dr. Bill Dust, an orthopedic surgeon in Saskatoon, said he lived through the Saskatchewan Doctors Strike in the 1960s, when many doctors protested the now-current funding model for the Canadian health care system.

He said many of the doctors he knows later changed their minds, realizing the modern publicly-funded system works.

Any serious changes to that system, he said, should be up to Canadians.

“It shouldn’t be up to doctors, it shouldn’t be up to politicians,” he told Global News.

“Two-tier systems — I think they can work. But I think in Canada we have what we have, and until Canadians tell me otherwise I’m happy to carry on as we’re doing.”

Otherwise, he said, he considered the matter settled.

He, like Ogieglo, also worried that private care did not reduce wait times. And he said he was worried it’s actually more expensive than publicly-funded care.

Global News asked Merriman for comment on the SCC decision.

In a statement, he repeated what he said in March regarding Ottawa’s announcement.

“We call on the federal government to reverse its decision to claw back these dollars and to recognize the benefits that Saskatchewan’s unique approach has for both patients and the public health system,” the statement reads.

When asked about the SCC’s refusal to hear the appeal for privately-funded health care, Ogieglo said he didn’t think the matter was settled.

“I think… it highlights that it’s important to fix our public system,” he said, listing things like access to mental health care and funding for supervised consumption sites.

“There’s very few areas of medicine that are not really struggling right now in our health care system.”

— with files from Simon Little and the Canadian Press