Wait-time guarantees for health services: an analysis of Quebec's reaction to the Chaoulli Supreme Court decision.
Bibliographic record
Abstract
The Quebec government's response to the Chaoulli Supreme Court decision (1) regarding unreasonable wait times and private health insurance has been to introduce guaranteed wait time limits for certain health care services. This article examines two documents: Guaranteeing Access: Meeting the Challenges of Equity, Efficiency and Quality (the White Paper), (2) and Bill 33, An Act to Amend the Act Respecting Health Services and Social Services and Other Legislative Provisions, passed and assented in December 2006. (3) An analysis of these documents shows that the government is suggesting not one but two separate guarantee mechanisms quite different from one another: a public guarantee on the one hand and a public-private guarantee on the other. The first, the public guarantee, is for all practical purposes already in place, even if not in those terms, for tertiary cardiology and radiation oncology services. Results of the use of this mechanism in the past few years have shown dramatic improvement to access to care. I welcome the expansion of the public guarantee for health care services in Quebec. However, the Quebec proposal also introduces a second type of guarantee, the public-private one, about which I express strong reservations. This guarantee is linked to staunch conservative ideology, as found in Canada and elsewhere, and it is part and parcel of the introduction of private health insurance for medical and hospital services, as well as contracting-out public services to private for-profit enterprises. Its main impact over the medium to long term will be the support of the legalization and expansion of private surgical facilities and, more broadly, the implementation of a parallel system of private medical and hospital care in Quebec. The public interest of Quebecers is poorly served by such an initiative. 1. The Supreme Court of Canada Decision in Chaoulli The Supreme Court of Canada rendered its judgement in the Chaoulli case on June 9, 2005. Few decisions in its recent history have attracted the same level of media attention as this one. The next day, startling headlines appeared in newspapers across Canada. (4) In a controversial and close decision, a 4-3 majority had concluded that, given the unreasonable wait times for access to certain health services, the ban on private insurance for services covered under Quebec's public hospital and health insurance legislation (5) violated section 1 of The Quebec Charter of Human Rights and Freedoms. (6) The decision became the subject of numerous commentaries, in law journals (7) and other specialized publications (8) as well as in the media. (9) The purpose of this paper is not to comment on the legal decision itself, but rather to offer an analysis of the Quebec government's response to the decision. Its proposals were first contained in its White Paper, Guaranteeing Access, published on February 16, 2006, and in large part confirmed in Bill 33, which was tabled in the National Assembly on the last day of the spring 2006 parliamentary session and became law on December 13, 2006. Quebec's Social Affairs Committee heard from more than 100 organizations and individuals that made written submissions in response to the White Paper. (10) I will from time to time make reference to some of these submissions. (11) It is worth noting that the Supreme Court's decision rests on the existence of unreasonable wait times, which threaten the right to life and to personal security guaranteed in section 1 of the Quebec Charter. (12) Therefore, the government had the opportunity to address wait times directly. It had three possible models at its disposal to ensure the right to health care, notably with respect to the problem of wait lists. Before examining the Quebec response more closely, it is useful to consider these three models briefly. 2. Three Models of Patients Rights Protection Canadians' concerns about the quality and accessibility of health care services are real and demand a response. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.021 | 0.006 |
| Scholarly communication | 0.014 | 0.003 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.015 | 0.013 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".