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In June 2005, the Supreme Court of Canada ruled that Quebecers have a constitutional right to buy private health insurance that would cover services already available and funded in the public health system. While this ruling only applies to Quebec – for the time being – Canadians have witnessed a steady stream of private and market-driven reforms into our public health system generally, including pressures by some for the introduction of private health insurance (PHI) for services already funded by public health care as an option for all Canadians.
But what would be the impact of PHI on women and their families?
Women and men stand to experience the effects of PHI differently, due to their different roles as users and providers of health care. As a result, Alison Jenkins, the author of Women and Private Health Insurance argues that it is crucial that we understand the implications of PHI for women, including women’s access to PHI, the impact of PHI on women as patients, health care workers and unpaid caregivers, and the effects of PHI on the public health care system.
With higher rates of chronic disease and greater reproductive health requirements, women both need and use more health care than men. As the majority of health care workers, women are among those most affected when health care financing affects providers’ livelihoods and working conditions. As the majority of unpaid caregivers, it is women who offer care not formally provided, and they who assume increasing burdens as access to formal care is limited. Given the importance of health care for women and their disproportionate involvement in health care provision, the implications of PHI for women are of particular importance.
Women as a group have less access to PHI due to their lower incomes and employment status. They also often face higher premiums and even outright denial of coverage. In addition, they risk unstable PHI coverage with changes in employment and personal status, such as divorce. Different women have different relationships to PHI, with those marginalized on the basis of factors such as class, race, sexuality, age, health status, ability and geographical location less likely to have this form of coverage.
As this study reveals, a lack of PHI coverage is likely to have negative consequences not only for the health of individual women, but also for their families and communities. Even when women do have PHI policies, these policies do not always cover the health care services that they need.
As patients, women with PHI may receive care more quickly, but findings about the quality of care provided are mixed, with research suggesting that PHI can lead providers to prefer profitable or even unnecessary procedures.
As health care workers, women can face deteriorating working conditions when they provide the private services that PHI covers. As unpaid caregivers, women can face both a lack of PHI coverage for their families and added work where PHI makes other forms of care inaccessible.
The impact of PHI on public health care systems is also a significant concern for women. Although it is sometimes assumed that PHI and public health care systems exist in isolation from each other, this is not usually the case. The available information suggests that PHI negatively impacts public health care systems and that this is to women’s detriment. Women stand to lose access to care when PHI undermines public health care systems by draining human resources and funding capacity and adding costs where previously care was publicly subsidized.
In Women and Private Health Insurance Jenkins suggest that PHI is detrimental to gender equity, negatively affecting women as patients, health care workers and unpaid caregivers. Jenkins provides extensive sections detailing the nature of PHI, women’s access to it, and the health consequences to women and their families when PHI becomes pervasive and public health systems erode.
As Jenkins concludes, PHI can affect not only the health care women receive, but also that which they provide, both paid and unpaid. This has significant ramifications for the health and well-being of all Canadians.
For the full report, visit:
www.womenandhealthcarereform.ca or contact: 1-888-818-9172.
For more on the Supreme Court decision (June 2005) on PHI, see:
“Private Health Insurance for Women? Fall-out from the Chaoulli decision” by Abby Lippman and Amélie Quesnel-Vallée