Two-tier health care - Definition and Overview

Two-tier health care is a form of national health care system that is used in most developed countries. It is a system in which a guaranteed public health care system exists, but where a private system operates in parallel. The private system has the benefit of shorter waiting times and more luxurious treatment, but costs far more than the public one for patients. Thus there are two tiers of health care, one for the public at large and another for those who are wealthy enough to pay for better care.

The term is most often used in Canadian health discussions. Unlike the vast majority of countries Canada does not have a parallel system, free market health care for Canadians being almost wholly banned in fields covered by the national health system; some private clinics and hospitals which were operating when the national health care plan was instituted (for example, the Shouldice Hospital in Thornhill, Ontario) continue to operate, although they may not bill additional charges for medical procedures. Private health care may also be supplied in uncovered fields and to foreigners. Furthermore, most Canadian hospitals of any type would be considered private institutions in some other countries, such as Australia. The term is generally used as a pejorative description for how the right wing would want to alter Canada's healthcare system.

The phrase is also sometimes used in other countries and among health care experts. In Europe it often has the same meaning as in the Canadian context, but is used there used to describe the status quo. However, sometimes it has a somewhat different meaning relating to the expansion of private sector involvement through voucher programs or other initiatives.

The debate over two-tier health care has long been a central one in Canada. Moving to such a system is supported by conservative think tanks such as the Fraser Institute. The potential for vast profits has created a strong lobby in the health industry, which is today confined to the periphery.

The proponents of two-tier system argue that it would introduce more flexibility into the system, reducing wait lists and that competition from the private sector would make the public one more efficient. Opponents argue that a two-tier system would tend to draw many of the best doctors out of the public system, reducing the overall level of care. The Canada Health Act is also committed not only access to health care to all, but access to the best health care available for all. Many on the left consider access to the best possible care an important right of all citizens. Competition from the private sector would also almost certainly drive up the wages of doctors and other medical professionals in the entire system.

Many two-tier systems do attempt to resolve these difficulties. Australia, for instance, requires all doctors to work some of their time in the public system. However, if care is not superior in the private system no one would use it so a certain imbalance between the care received by the rich and the poor exists in all two-tier systems.

In part because of these issues, but also due to the belief that anything making Canada more like the United States is undesirable, the Canadian people are overwhelmingly opposed to the notion of two-tier health care. Alleging secret support for two-tier health care a common method of attacking Canada’s right-wing parties, and one that has been very successful, especially in the last two elections.

Some argue that Canada already does have a two-tier health care system as the very wealthy can go to the United States for treatment, and quite a few Canadians do each year.

See also: Canadian and American health care systems compared, health care system