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Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care

Published online by Cambridge University Press:  01 July 2010

Colleen M. Flood*
Canada Research Chair in Health Law & Policy, Faculty of Law, University of Toronto and Scientific Director, CIHR Institute of Health Services and Policy Research, Canada
Amanda Haugan
JD student, Faculty of Law, University of Toronto, Ontario, Canada
*Correspondence to: Colleen M. Flood, CIHR – Institute of Health Services & Policy Research, Faculty of Law, University of Toronto, 39 Queen’s Park Crescent East, Toronto, Ontario M5S 2C3, Canada. Email:


Choice is often touted as a means for change within health care systems. Yet ‘choice’, in this context, takes at least three distinct forms: choice between providers within a publicly funded health care system; choice between competing insurers within a universal plan; and, lastly, choice as between privately financed health care and universal public coverage. In Canada, it is this last form of choice that is under active debate; particularly in light of the Supreme Court of Canada’s decision in Chaoulli, which found a regulation banning private health insurance for medically necessary care was unconstitutional. The argument is frequently made that Canada is an outlier from other countries in having regulation that effectively precludes this kind of choice. This issue is likely to become of concern again in upcoming constitutional challenges where applicants are looking to overturn through judicial challenges Canada’s medicare system. This article tests that argument of whether Canada truly is ‘odd’ from a comparative policy perspective by exploring regulation of choice of privately financed health care in several European countries – the Netherlands, Germany, Sweden, England and France. We highlight commonalities as well as differences, showing the extent to which these countries employ regulation to fetter growth of a large privately financed sector. The article’s thesis is that Canada, in employing more intrusive forms of regulation, is not an outlier per se but at one point in a regulatory spectrum.

Copyright © Cambridge University Press 2010

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