Accessible health care
======================

* Richard D. Cohen

*   © 2007 Canadian Medical Association or its licensors

I commend Meridith Marks and Robert Teasell for drawing attention to the problems faced by Canadians with disabilities in accessing the health care system.1 However, I believe the most fundamental threat to the well-being of these patients resides in the potential for expansion of the private health care insurance industry in this country.

By stipulating that health care must be accessible, universal and publicly administered, the Canada Health Act de facto ensures that people with disabilities are not denied health care coverage or do not have their coverage loaded (i.e., higher premiums to reflect greater actuarial risk). Although health care funding in Canada is not calculated actuarially, its costs are shared by all Canadians through their taxes.

Private insurance companies operate on a for-profit basis. They employ actuarial methods to screen applicants for conditions that represent an insurance risk. People with disabilities or other pre-existing medical conditions who applied for private coverage would therefore face higher, perhaps unaffordable, premiums or would be denied coverage altogether. The publicly funded health care system would have an uncertain future in a 2-tiered scenario, but people with disabilities and chronic conditions would be completely dependent on it.

I believe that guaranteed and affordable insurance is the cornerstone of health care access for patients with disabilities and chronic conditions. All Canadian physicians should work to ensure that such insurance is not jeopardized.

## REFERENCE

1.  1. Marks MB, Teasell R. More than ramps: accessible health care for people with disabilities [editorial]. CMAJ 2006;175(4):329.
    
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