\t\tRead: 5 min<\/p>\n
Over 20 years ago, a Supreme Court of Canada decision put Quebec\u2019s health-care system on a different trajectory than the rest of Canada\u2019s.<\/p>\n
In a 2005 decision known as Chaoulli, the court struck down Quebec\u2019s ban on private insurance for some medically necessary services, ruling that lengthy wait times could violate patients\u2019 rights.<\/p>\n
In the years since then, Quebec has seen more private surgical clinics open and more publicly funded procedures performed in private facilities.<\/p>\n
Experts are divided on whether the resulting expansion of private delivery has been a net positive for the province.<\/p>\n
\u201c[H]ospitals have been slowly transferring some volumes of surgeries in private clinics, surgeries that would be paid for by the public system \u2026 in order to alleviate the wait list,\u201d said Yanick Labrie, a Quebec-based economist and senior fellow at the Fraser Institute think tank.<\/p>\n
\u201cI think it could be emulated in the rest of Canada.\u201d<\/p>\n
But critics argue the model diverts scarce public resources.\u00a0<\/p>\n
\u201cThe surgeries that are funded by public funds and delivered in private clinics \u2014 it\u2019s public doctors that are doing those surgeries,\u201d said Anne Plourde, a researcher at L\u2019Institut de recherche et d\u2019informations socio\u00e9conomiques (IRIS).<\/p>\n
\u201cWe are just taking doctors from public settings and putting them in private clinics.\u201d<\/p>\n
Chaoulli v. Quebec<\/p>\n
The Chaoulli case centred on a Quebec law that prohibited patients from holding private health insurance for medically necessary services, such as hip replacement surgery.\u00a0<\/p>\n
In a 4\u20133 decision<\/a>, the court held that banning private insurance amid long wait times violated patients\u2019 rights under Quebec\u2019s Charter of Human Rights and Freedoms.\u00a0<\/p>\n Three justices also found a violation of the Canadian Charter of Rights and Freedoms. But since that finding was not binding, the ruling applied only in Quebec.<\/p>\n In response, Jean Charest\u2019s government passed Bill 33, a law that allows Quebecers to purchase private insurance for just three procedures: hip replacements, knee replacements and cataract surgeries.\u00a0<\/p>\n \u201cIn most provinces, you\u2019re not allowed to have that kind of [insurance] product available,\u201d said Labrie.\u00a0<\/p>\n Ultimately, though, the law\u2019s narrow scope limited insurers\u2019 interest in providing coverage.\u00a0<\/p>\n \u201cIt\u2019s like you\u2019re allowed to buy a car, but there are no cars,\u201d said Labrie.\u00a0<\/p>\n \u201cPeople would be willing, probably, to buy such insurance, but no insurance companies are interested in providing that type of insurance.\u201d<\/p>\n What actually changed?<\/p>\n However, Chaoulli did nonetheless have an impact on Quebec\u2019s health-care system.\u00a0<\/p>\n The decision created legal and political pressure to address wait times. And it helped legitimize a larger role for private-sector involvement, Labrie says.<\/p>\n \u201cPrivate clinics were allowed a greater role in the publicly funded system,\u201d he said.\u00a0<\/p>\n The bill also expanded the government\u2019s ability to purchase publicly funded surgeries from those clinics.<\/p>\n Today, medically necessary services remain funded by the province. But an expanding share of publicly funded diagnostic services, procedures and surgeries are delivered in private clinics.<\/p>\n Quebec is not unique in this respect, but it has gone further than most.\u00a0<\/p>\n In 2025, nearly 20 per cent of surgeries in Quebec were performed in publicly funded private clinics \u2014 a level only matched by Alberta.\u00a0<\/p>\n In B.C., by contrast, just under five per cent of surgeries were delivered in private clinics in the 2021-22 fiscal year. Meanwhile, Manitoba, New Brunswick, P.E.I. and Newfoundland and Labrador have minimal to no private surgical capacity. (Ontario does not publish a comparable system-wide percentage.)<\/p>\n The number of specialized medical centres in Quebec has also grown, from 45 facilities in 2014 to 73 in 2023. Most of these centres\u2019 procedures are still publicly funded, according to a 2025 report<\/a>.<\/p>\n Taken together, Labrie argues these figures point to a greater reliance on private surgical delivery than seen in most provinces.\u00a0<\/p>\n \u201cTo some extent, other provinces have introduced some sort of reforms \u2026 but nothing compared to Quebec in terms of consistency,\u201d he said.\u00a0<\/p>\n Labrie says long wait times and physician shortages have also contributed to greater public openness toward private-sector involvement in Quebec.<\/p>\n \u201cWe\u2019re not different from other provinces. We do have to operate under the Canada Health Act \u2026 [but] there\u2019s not the backlash and the \u2026 opposition that we generally see in the rest of Canada about the private sector in health care,\u201d he said.\u00a0<\/p>\n \u201cIt\u2019s something that we just feel comfortable having \u2026 in Quebec.\u201d<\/p>\n Is it working?<\/p>\n But among experts, Quebec\u2019s evolution remains contentious.\u00a0<\/p>\n Plourde, of IRIS, says the expansion of private delivery is drawing workers and surgical capacity away from the public system. She points to workforce data<\/a> revealing a long-term shift in labour from the public network into private delivery.<\/p>\n Quebec\u2019s reforms under Bill 33 also enabled physicians to fully opt out of the public plan and bill patients directly, including for primary care. A 2023 investigation<\/a> by the Globe and Mail found the number of Quebec doctors that are fully private has more than doubled over the past decade.<\/p>\n Plourde says these changes leave the public system \u2014 which still handles emergencies, cancer operations and complex cases \u2014 with the sickest patients, and fewer resources to treat them.\u00a0<\/p>\n She also notes that the province may be spending more as a result of its reliance on private facilities. A 2023 IRIS analysis<\/a> found some procedures cost as much as 150 per cent more in private settings.<\/p>\n Dr. Shaun Selcer, an internist at the Montreal Heart Institute and assistant professor at Universit\u00e9 de Montr\u00e9al, says he sees many patients who have \u201cconsulted in the private sector.\u201d<\/p>\n \u201cMy personal impression is that many are willing to pay for private care, although it does not always address the underlying medical issues,\u201d Selcer said in an email.\u00a0<\/p>\n \u201cI also think the private system often distinguishes itself more through accessibility and customer service than through medically necessary care.\u201d<\/p>\n The impact on wait times also remains unclear.\u00a0<\/p>\n According to a 2024 Fraser Institute report<\/a>, Quebec had the shortest median wait for an initial specialist consultation at nine weeks. P.E.I. had the longest wait, at nearly 40 weeks.<\/p>\n However, the wait time from the initial referral to treatment in Quebec was nearly 29 weeks \u2014 right around the nationwide average of 30 weeks.\u00a0<\/p>\n Cambie in B.C.<\/p>\n The Chaoulli ruling never established whether long wait times violated the Charter rights of residents of other provinces.<\/p>\n