Duplicate health insurance | Advantageous… if you can afford it

In response to the letter from Maria Lily Shaw of the Montreal Economic Institute on duplicate health insurance⁠1published on January 20

In her article of January 20, Maria Lily Shaw presents duplicate insurance as having a “double advantage”, that of allowing the insured to wait less long on the waiting lists and that of reducing the pressure on the public system. . We are talking about a tool for protecting the right to health. However, how can we speak of a right to health if only a minority of the population would benefit from it? Do more complex patients, generally older and more vulnerable, who cannot afford private insurance, have a lesser right to health?

The “double advantage” mirage

Instead of using patient satisfaction, let’s look at objective data from the countries cited by Mme Shaw.

Australia, for example, introduced a parallel private system in 1997 and public patients now wait twice as long as private patients for their operations.⁠2.

Additionally, due to out-of-pocket payments, citizens in the lowest socioeconomic group are 37% more likely to die of cancer than those in the highest socioeconomic group.⁠3. Do we really want to open the door to such a deeply unfair scenario in Quebec?

In the United Kingdom, researchers from Oxford University have come to the conclusion that the increase in outsourcing to the private sector is significantly correlated with the increase in mortality rates⁠4.

Increased pressure on the public system

Let’s be clear. Allowing duplicate insurance means allowing people to take precedence over others. However, this does not create workers and therefore does not increase the capacity of the whole system to perform more operations.

In a context of glaring labor shortage, where will we find the health professionals so necessary to the public network when the private sector hires them?

Recently, the Supreme Court of British Columbia examined the impact of paid private health care in its 2020 decision in the Cambie case and found that, according to studies, when duplicate insurance is permitted, physicians reduce their time and effort for the public system. This necessarily leads to an increase in waiting times for care in the public system. It is simply wrong to say that such measures reduce the pressure on the public system.

Finally, it is recognized that a single-payer system (a single insurance system) is more economical and makes it possible to maximize resources that directly benefit patients.


Since the decree of December 7, passed on the sly, nothing now prevents a doctor from abandoning his waiting lists in the public network to favor patients who pay more in telemedicine. In addition, the government allows telemedicine services to be covered by an employer’s insurance.

This necessarily leads to a two-tier insurance system and, in short, to two classes of citizens.

Until now, the prohibition for doctors to be paid both by the state (participating doctor, paid via the RAMQ) and by the private sector (individuals, insurers, etc.) prevented them from selecting the simplest cases. (and more paying) by moving them more quickly to private.

The rise of telemedicine is a major step forward in access to care. Why should this advancement only benefit the wealthiest?

In Quebec, access to health care must be based on need and not on the ability to pay. We call on the government to back down on the decree of December 7 in order to guarantee the right to health for all Quebecers.

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