The Supreme Court of Canada has struck down Quebec's ban on using private insurance for services covered under medicare.

Four of the court's seven judges involved in the decision wrote that the ban was in violation of the province's Chart of Rights:

• "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."

• "The evidence also demonstrates that the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness."

But the country's top court was divided on whether the Canadian Charter of Rights has been violated. One judge abstained so the vote was split 3-3.

The ruling means that Quebecers can essentially begin paying for health services immediately.

But the Quebec government is asking the Supreme Court to delay the implementation of its ruling for six months to two years. It may also choose to use the notwithstanding clause to override the ruling.

Though the 100-page ruling will not directly affect other provinces, many agree that similar legal challenges will now be launched across the country.

Dr. Albert Schumacher, president of the Canadian Medical Association, says the ruling could "fundamentally change the very foundations of medicare as we now know it.''

He called it "a stinging indictment of the failure of governments to respond to the mountains of studies that show we need real action on our health care system."

The case stemmed from a Quebec patient named George Zeliotis who argued that his constitutional rights to life, liberty and security of the person were violated by a year-long wait for a hip replacement.

Zeliotis brought his fight to the Supreme Court along with his physician, Dr. Jacques Chaoulli, who said he was fed up with the current system and wanted the right to set up a private medical business.

They asked the court to overturn portions of the Quebec Health Insurance Act and Quebec Hospital Insurance Act that prohibit buying private health insurance for medically necessary services.

Zeliotis wondered why he could buy health insurance that would pay for such things outside of public medicare as prescriptions, physiotherapy or private hospital rooms, but couldn't buy insurance that would allow him to skip to the front of the waiting line.

Zeliotis and Chaoulli argued that spending months waiting for surgery amounts to a violation of their constitutional rights.

Although two lower Quebec courts had ruled against the pair, the Supreme Court agreed with their argument.

Thursday's ruling means that Quebecers can now sidestep waiting lists by paying for faster medical treatment -- at least until a new law is created.

Sharon Sholzberg-Gray of the Canadian Health Care Association says she doesn't expect an immediate health system revolution and doesn't think this is "the last word of the Supreme Court."

"It might well be that there will be other solutions that will come forward," she told reporters in Ottawa.

CMA hoping for change

The CMA's Schumacher says he was surprised that the court decided its ruling would take effect immediately. But he says that'll certainly goad the government to hasten its reforms.

"This is going to crank up the speed of the treadmill significantly," he told reporters. 

As for the pair who launched the challenge, Chaoulli is pleased with today's decision and doesn't believe the ruling discriminates against the poor. He says it means no more wait times for everybody.

Lawyer Phillippe Trudel, who's representing Zeliotis, told Canada AM ahead of the ruling that he didn't believe that a decision in his client's favour would lead to the destruction of the public health system.

"It's important to point out that my client is in favour of a very strong public system. But what he wants is the option to go outside the public system if the waiting times are too long."

"A parallel private system functions very good in most European countries and there's no collapse of the public system," Trudel added.