Warning message

Please note that this page is from our archives. There may be more up-to-date content about this topic on our website. Use our search engine to find out.

On July 30, 2007, the Canadian Medical Association (CMA) released a policy statement calling on governments to expand private insurance and private clinics and to allow doctors to charge the public system and top-up with private-paying clients.

The CMA is advocating for-profit insurance and delivery despite evidence that it costs more, harms patients, and makes wait lists longer.

What does the evidence say about dual practice?

The CMA wants doctors to be allowed to work in both the public system and the private system at the same time.

In the UK, Australia and New Zealand, specialists are employed on a salaried basis in the public sector and a fee-for-service basis in the private sector. They have a financial incentive to maintain long waiting lists in their public practice to generate demand for private-pay services.1

What does the evidence say about for-profit delivery?

The CMA wants public funding routed to for-profit providers.

Research has shown that OECD countries with parallel private hospital systems have larger and longer public wait lists than countries with a single-payer system2. Private providers exacerbate waiting list problems because:

  • They attract doctors and other health care providers, already in short supply, away from the public system.
  • Doctors practicing in both systems have an incentive to boost their private practice by keeping waits long on the public side.
  • Private clinics and hospitals tend to “cherry pick” patients who are healthier and younger. They cater to the “easier” non-emergency cases, leaving the more costly ones to the public system.3

For-profit facilities also deliver a lower standard of care. Investor-owned nursing homes are more frequently cited for quality deficiencies and provide less nursing care4, and investor-owned hospices provide less care to the dying5, than non-profit facilities. For-profit hospitals and dialysis clinics have higher death rates.6

For more information on how dual practice, private insurance and for-profit delivery would undermine Medicare, see: Assessing the International Evidence, CUPE Research, 2005.

What does the evidence say about private insurance?

The CMA wants private insurance for medically necessary services.

Countries with social justice and equity goals spend considerable energy restricting the private insurance industry because it tends to increase costs and discriminate against already marginalized groups in society. While few countries explicitly ban private insurance for hospital and physician services, many arrive at the same end by different means.7

What are true solutions for strengthening Medicare?

There are a number of excellent projects recently completed or now underway that demonstrate public solutions to our health system challenges. To rein in health care costs, we need a national pharmacare strategy that includes first-dollar coverage for essential drugs on a national formulary, bulk purchasing, evidence-based prescribing, and stricter controls on drug marketing. To reduce waits, we need governments at the federal and provincial/territorial levels to invest in health human resources and public infrastructure and to advance centralized lists, case management, team-based care, and population health planning. Public non-profit home, community, and long-term care need immediate investment and national standards. Above all, the solutions must strengthen and expand Medicare as a publicly-funded and publicly-delivered program meeting Canada Health Act standards.

For more information on public solutions, see:


1 Tuohy, C. H., Flood, C. M., & Stabile, M. (2004). How does private financing affect public health care systems? Marshaling the evidence from OECD nations. Journal of Health Politics, Policy and Law 29(3): 359-396.

2 Ibid.

3 Canadian Health Services Research Foundation (2005). Myth: A parallel private system would reduce waiting times in the public system. Ottawa, ON: CHSRF Myth Busters series; Lister, J. (2005). Health Policy Reform: Driving the wrong way? A critical guide to the global ‘health reform’ industry. London: Middlesex University Press; Tuohy et al (2004).

4 McGregor, M. J., Cohen, M., McGrail, K., Broemeling, A. M., Adler, R. N., Schulzer, M., et al. Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? (2005). Canadian Medical Association Journal 172(5): 645-9; Harrington, C., Woolhandler, S., Mullan, J., Carrillo, H., & Himmelstein, D.U.(2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health 91: 1452-55.

5 Carlson, M. D. A., Gallo, W. T., & Bradley, E. H.(2004). Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey. Med Care 42: 432-8.

6 Devereaux, P. J., Choi, P. T., Lacchetti, C., Weaver, B., Schunemann, H. J., Haines, T., et al. (2002).
A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. Canadian Medical Association Journal 166(11): 1399-406; Devereux, P. J., Schunemann, H. J., Ravindran, N., Bhandari, M., Garg, A. X., Choi, P. T., et al. (2002). Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. Journal of the American Medical Association 288(19): 2449-57.

8 Flood, C. M., & Sullivan, T. (2005). Supreme disagreement: The highest court affirms an empty right. Canadian Medical Association Journal 173(2).