Allegations of the existence of a two-tier health care system in Canada - one where some people get faster access than others for reasons unrelated to their health condition - have been made for a number of years. A public inquiry currently underway in Alberta investigating allegations of "queue jumping" and related preferential treatment in the health care system (the "Inquiry")1 may provide some credence to those allegations. Until recently, the general consensus on the Inquiry was that it had yet to produce a "smoking gun". However, in recent weeks, the Inquiry attracted significant media attention as a result of witness testimony that lends some support to claims of disparity in access to health care in Alberta.
Background of the Inquiry
By way of background, the Inquiry was ordered by Premier Alison Redford in February 2012 in response to various allegations that some patients in the Alberta health care system were receiving preferential care.2 One such high-profile controversy related to allegations that a public colon cancer screening centre in Calgary (the "Centre") was putting patients referred to it by a certain private clinic, for routine screening, to the front of the line (the "Cancer Screening Allegations"). There were also allegations that politicians were interfering with the health care system and "pushing personal agendas" by using healthcare as an avenue for "political gain".3
The $10 million Inquiry headed by Justice John Vertes is the first of its kind in Canada. Directed to "determine whether improper preferential access to publicly funded health services is occurring," he is to make recommendations, if any is found, "to prevent future improper access."4 Facing criticism that the scope of the Inquiry is too narrow because it does not extend to claims of interference by politicians in health care, nor address the issue of physician intimidation5, Redford has clarified that "the Inquiry can follow the evidence where it leads".6
The Inquiry commenced in December 2012. It is currently in the evidence gathering stage with witnesses having testified in Edmonton and in Calgary over the last two months. Witnesses have included representatives of Alberta Health Services and the Calgary Health Region (now amalgamated with Alberta Health Services); leaders of the Alberta Liberal Party and Alberta NDP; hospital executives; and the Alberta health minister, the Honourable Fred Horne. Public hearings are scheduled to continue February 19 through to March 1, 2013. The report summarizing the findings and recommendations of the Inquiry is due April 30, 2013.
Until recently, no particularly controversial evidence had been put forward at the Inquiry. However, testimony was recently given regarding the Cancer Screening Allegations that attracted considerable attention. Specifically, clerks from the Centre testified that patients who were referred from a private health care clinic (the "Private Clinic") were given urgent priority even if their health condition was not considered high risk.7 The Private Clinic patients would generally receive screenings at the Centre within weeks while non-priority patients often had to wait years.8 The medical director of the Centre, in his testimony before the Inquiry, denied that clerks were told to allow patients from the Private Clinic to jump the queue.9
The Inquiry also recently heard that in 2009 some professional hockey players were able to by-pass five-hour line-ups at public clinics by receiving H1N1 vaccinations through a private session. The private session occurred the day before Alberta Health Services announced a vaccine shortage and began closing flu shot clinics.10
The consequence of a finding of improper preferential treatment in the system is not clear. Currently in Alberta, like many other provinces, there is legislation that prohibits queue jumping.11 However, while there is an implication in the governing legislation that publicly funded medical services should be allocated on the basis of relative need, there is no federal or provincial legislation that dictates how waiting lists are to be structured or wait times allocated.12
One argument that Justice Vertes may have to grapple with is that various (legal) forms of preferential, or inequitable, access to care are already built into the health care system. For example, when a person purchases a diagnostic service at a private facility (either in province where permissible or out of province where not) instead of waiting months for the publicly funded option, and the results demonstrate that some kind of treatment is required, that person has, arguably, been fast tracked towards treatment, as compared to someone who waited for the publicly funded diagnostic test.13 As another example, certain categories of people are excluded from the public health insurance plans, such as workers injured on the job, because they receive funding for health care services from other public sources and, in some cases, those individuals can receive medical care faster than the general public.14 As such, if Justice Vertes concludes that "improper preferential access" exists in the system, it will be interesting to see how that term is defined and whether, or how, it is reconciled with these others types of inequality in the system.
1 Health Services Preferential Access Inquiry, online: https://healthaccessinquiry.com/
2 "Terms of Reference", Health Services Preferential Access Inquiry, online: https://healthaccessinquiry.com/assets/pdf/Terms-of-Reference.pdf
3 "Review of the Quality of Care and Safety of Patients Requiring Access to Emergency Department Care and Cancer Surgery and the Role and Process of Physician Advocacy", Health Quality Council of Alberta (February 2012), online: http://www.hqca.ca/assets/files/EDCAP%20FINAL%20REPORT.pdf
4 Supra note 2, page 3.
5 Shawn Logan, "Wildrose leader Danielle Smith calls queue-jumping inquiry a waste", Calgary Sun (December 11, 2012), online: http://www.calgarysun.com/2012/12/11/wildrose-leader-danielle-smith-calls-queue-jumping-inquiry-a-waste ; "President's Letter", Alberta Medical Association (February 29, 2012), online: https://www.albertadoctors.org/Media%202012%20PLs/Media_pub_preslet_29feb12_LTR.pdf
6 "Queue-jumping inquiry won't be a witch hunt", CBC News (October 15, 2012), online: http://www.cbc.ca/news/canada/edmonton/story/2012/10/15/edmonton-health-queue-jumping-inquiry.html
7 Transcript Volume 24 (January 15, 2013) of the Health Services Preferential Access Inquiry, at pages 1946-1950, online: https://healthaccessinquiry.com/transcriptions
9 Transcript Volume 26 (January 16, 2013) of the Health Services Preferential Access Inquiry, at page 2098, online: https://healthaccessinquiry.com/transcriptions
10 "H1N1 clinics suspended due to vaccine supply issues", Alberta Health Services (October 31, 2009), online: http://www.albertahealthservices.ca/927.asp
11 Health Care Protection Act, RSA 2000, c H-1, s. 3.
12 Transcript Volume 1 (December 3, 2012) of the Health Services Preferential Access Inquiry, at page 76-77, online: https://healthaccessinquiry.com/transcriptions
13 Ibid, page 48-49.
14 Ibid, page 44.
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