As all CIMCA members know, both private health care and health insurance systems are currently experiencing significant change. The changes that are coming will likely be equally important to both patients and those who pay for their care.

As a health insurance lawyer with OneWorld Medicare and the TU Group of companies, and with a background in political science and constitutional law, I bring a rather unusual and unique perspective to health care. For the past 19 years, I have worked ever increasingly in the field of medical insurance, both in Canada and internationally, reviewed medical files from countries around the world, and observed public and private health care and insurance systems in action.

This article is the first in a series that will address how we arrived at the current Canadian health care and health insurance systems and examine how these systems will likely change in the foreseeable future. The series will highlight the difference between health care and health insurance - a vital distinction in order to understand how the systems work.

Health care is providing and receiving medical services. In Canada many such services are provided in provincial government owned hospitals. However, a large proportion are provided in privately owned clinics and other facilities. Virtually every doctor’s office in the country is a “private clinic” in that doctors own them and operate them as businesses.

One of the most prevalent myths about Canadian health care is the suggestion that the Canada Health Act requires government owned and operated hospitals and prohibits private clinics. In fact, the Act says nothing about how or where health care is delivered, and only addresses who pays for health care.

An analogy with car insurance and repair illustrates the point. In B.C. and Manitoba, the provincial governments operate car insurance programs that have monopolies or quasi-monopolies. In other words, people pay money to the provincial government or one of its crown corporations and, when there is an accident, the government pays for the repairs (minus the user fee, or “deductible,” which is meant in part to encourage safe driving and prevent overuse of the system, which seems common sensical, doesn’t it?). However, no one advocates, and no politician intent on re-election would suggest, that provincial governments should also own and operate the repair shops that have their bills paid by the provincial auto insurance companies.

Now consider the difference between health care and health insurance. The people, businesses and government departments that provide health services expect to be paid. At this stage, health insurance becomes significant. Provincial medical insurance plans are government run systems that receive money from taxpayers, through premiums or allocation of government revenue, or both. These plans currently pay about 70% of the cost of health care received by Canadians. The balance is paid by a combination of private insurance and direct payments by patients. It is the question of payment for health care, not who provides it or where, that is addressed by the Canada Health Act.

The next article in this series will examine the Canada Health Act in more detail, its constitutional foundation and limitations, and what it really means.

Kieran Bridge is General Counsel for TU Group of Companies. TU Group of companies provides unique insurance and health care solutions. Notable member companies in TU Group include Travel Underwriters, OneWorld Assist, and OneWorld Medicare. Visit us at: www.tu-group.com.

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