A surprise ruling of the Supreme Court of Canada that struck down a Quebec prohibition on private health insurance in that province has raised fears that a two tier health care system will arise to replace the whole country's universal publicly funded system. Until now, Canadians have not been allowed to buy health insurance to cover services provided by the publicly funded system, even though there are long waits for some of these services. The decision of the court is likely to result in residents of other provinces also challenging the ban.

The court judgment was given in a case brought by Jacques Chaouilli, a Quebec doctor whose patient, George Zeliotis, had waited nearly a year for hip replacement surgery. Dr Chaouilli and Mr Zeliotis argued that Quebec's ban on buying private insurance for services already covered by the public …