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1. Introduction
Resource constraints in the health care system, and the inevitable allocation choices that must be made, are pressing issues in Canada. Even if governments were to devote all their funds to the health care system, choices and value trade-offs would still have to be made. Like most developed countries, the equation for Canada is simple: health care expenses, if not restricted, could easily grow at a faster pace than revenue.2
The consequence of resource constraints for Canada and other countries is that they must set a ceiling on the otherwise limitless health care needs to be funded publicly, leaving citizens to pay themselves (or through private insurance policies) for those health care services that are not covered publicly. In Canada, "medically necessary" services are provided free of charge; this has historically included, at least for the most part, physician and hospital services.3 Even where services are provided as part of the public system, there are challenges in meeting the demand, leading to long waiting lists for certain types of health care services.
In the province of Quebec, following the Supreme Court decision in Chaoulli v. Quebec (Attorney General)4, medical travel could become an option through private insurance packaging. The Chaoulli decision, and the Quebec government's subsequent response to it, changed the face of the health care system by allowing people to jump the queue of the public system by purchasing private insurance for some medically necessary services. While this is allowed for a limited number of treatments, for instance hip and knee replacement surgeries, cataract extraction and intraocular lens implantation5, medically necessary services open to private insurance are arguably doomed to enlarge. The Quebec Government leftopen the possibility of including more medical treatments in this category and has already considered the introduction of new services in the future.6 Turner argues that the Chaoulli decision and the Canadian Charter of Rights and Freedoms7 provide the basis for a legal argument that provinces ought to reimburse medically necessary care obtained outside Canada when there is a risk of death or irreversible tissue damage.8
This article raises the question of whether a viable policy option to ease pressure on health care systems across Canada might be for patients to travel abroad to obtain certain health...