Course:Law3020/2014WT1/Group G

Facts
In Quebec in 2005 the provincial government was prohibiting Quebec residents from taking out insurance to obtain private sector health care services through regulations in the Quebec Health Insurance Act and the Hospital Insurance Act. Seventy-three year old Quebec resident George Zeliotis was experiencing several health problems, including a hip replacement, that lead him to speak out against the waiting times he was experiencing due to Quebec's public health care system. A physician, Dr. Jacques Chaoulli, had also been attempting to have his home-delivered medical activities recognized, as well as to obtain a license to operate an independent hospital in his city, both of which were considered private medical care.

Both Zeliotis and Chaoulli took issue with the validity of the prohibition on private health insurance: s.15 of the  Health Insurance Act (HEIA) and s.11 of the  Hospital Insurance Act (HOIA). They claimed that these prohibitions deprived Quebec citizens of access to health care services that did not come with the extraneous waiting times that existed in the public system.



Issue(s)
The main question at hand in Chaoulli v. Quebec was whether Quebec had the constitutional authority to establish a single-tier health plan while discouraging a second private tier health sector through specific prohibitions, and whether these prohibitions infringed a person's section 7 right from the Canadian Charter of Rights and Freedoms?

If so, was this deprivation of a person's section 7 Charter right in accordance with the principles of fundamental justice?

Section 15 of the Health Insurance Act
15. An insurer or a person administering an employee benefit plan may enter into or maintain an insurance contract, or establish or maintain an employee benefit plan, as the case may be, that includes coverage for the cost of an insured service furnished to a resident or temporary resident of Québec, only if


 * (1) the insurance contract or employee benefit plan does not cover any insured service other than the insured services required for a total hip or knee replacement, a cataract extraction and intraocular lens implantation or any other specialized medical treatment determined under section 15.1, and those required for the provision of the preoperative, postoperative, rehabilitation and home care support services described in section 333.6 of the Act respecting health services and social services (chapter S-4.2);


 * (2) the insurance contract or employee benefit plan includes coverage for the cost of all insured services and all preoperative, postoperative, rehabilitation and home care support services referred to in subparagraph 1, subject to any applicable deductible amount; and


 * (3) the coverage applies only to surgery performed or any other specialized medical treatment provided in a specialized medical centre described in subparagraph 2 of the first paragraph of section 333.3 of the Act respecting health services and social services.


 * An insurance contract or employee benefit plan inconsistent with subparagraph 1 of the first paragraph that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract or plan must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.


 * Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec or the excess cost of any medication of which the Board assumes payment from being entered into or established. Nor does anything in this section prevent an insurance contract or an employee benefit plan that covers the contribution payable by an insured person under the Act respecting prescription drug insurance (chapter A-29.01) from being entered into or established.


 * “Insurer” means a legal person holding a licence issued by the Autorité des marchés financiers that authorizes it to transact insurance of persons in Québec.


 * “Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.


 * An insurer or a person administering an employee benefit plan that contravenes the first paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

Section 11 of the Hospital Insurance Act
11. No insurer may enter into or maintain an insurance contract that includes coverage for the cost of an insured service furnished to a resident.


 * No person may establish or maintain an employee benefit plan that includes coverage for the cost of an insured service furnished to a resident.


 * An insurance contract or employee benefit plan inconsistent with the first or the second paragraph, as the case may be, that also covers other goods and services remains valid as regards those other goods and services, and the consideration provided for the contract must be adjusted accordingly unless the beneficiary of the goods and services agrees to receive equivalent benefits in exchange.


 * Nothing in this section prevents an insurance contract or an employee benefit plan that covers the excess cost of insured services rendered outside Québec from being entered into or established.


 * “Insurer” means a legal person holding a licence issued by the Autorité des marchés financiers that authorizes it to transact insurance of persons in Québec.


 * “Employee benefit plan” means a funded or unfunded uninsured employee benefit plan that provides coverage which may otherwise be obtained under a contract of insurance of persons.


 * An insurer or a person administering an employee benefit plan that contravenes the first or second paragraph is guilty of an offence and is liable to a fine of $50,000 to $100,000 and, for a subsequent offence, to a fine of $100,000 to $200,000.

Analysis
The court found that delays which are the necessary result of waiting lists increase a patient's risk of mortality or the possibility of their injury/condition becoming much worse. This waiting period is often filled with pain and a lack of enjoyment of patients life, due to their urgent need for medical treatment. The court found that this was a clear violation of an individual's section 7 Canadian Charter right.

After a Charter infringement is made out, the provision that infringes upon the right can sometimes be protected under s.1. as a justified infringement. The objective of the HOIA and the HEIA is to make high-quality health care available to the citizens of Quebec, even though they may lack adequate funds. Therefore, the purpose of the provisions being examined are to prohibit private insurance in order to preserve the integrity of the public health care system in Quebec. A s. 1 justified infringement test requires that there be a rational connection between the purpose and the measures adopted, but here there was no compelling evidence presented establishing a rational connection between the objective of preserving the public plan and the limitations on a two-tier health care system.

The evidence presented to the courts showed that delays in public health care were widespread, and in some cases had serious consequences, such as death, as patients were forced to wait for proper medical attention. This evidence showed that the prohibition against private health care insurance/systems could lead to physical and psychological suffering.

Conclusion/Holding
According to the Supreme Court of Canada the appeal should be allowed. The Court decided that section 15 of the HEIA and section 11 of the HOIA are inconsistent with the Quebec Charter.

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