'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 Supreme Court ruled.

The high court stopped short of striking down the constitutionality of the country's vaunted health care system nationwide, but experts across the legal spectrum said they expected the decision to lead to sweeping changes in the Canadian health care system.

"The language of the ruling will encourage more and more lawsuits and those suits have a greater likelihood of success in light of this judgment," said Lorne Sossin, acting dean of the University of Toronto law school.

An Element of Timely Care

Patrick Monahan, dean of the Osgoode Hall Law School of York University in Toronto and a well-known critic of the national health care system, was even more emphatic about the importance of the decision.

"They are going to have to change the fundamental design of the system," he said. "They will have to build in an element of timely care or otherwise allow the development of a private medical system."

The Canadian health care system provides free doctor's services that are paid for by taxes. The system has generally been strongly supported by the public, and is broadly identified with the Canadian national character. Canada is the only industrialized county that outlaws privately financed purchases of core medical services.

But in recent years patients have been forced to wait longer periods for diagnostic tests and elective surgery while the wealthy and well connected either sought care in the United States or used influence to jump medical lines.

The court ruled that the waiting lists had become so long that they violated patients' "life and personal security, inviolability and freedom" under the Quebec charter of human rights and freedoms, which covers about one-quarter of Canada's population.

Delays Can Be Deadly

"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 Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."

The case was brought to the Supreme Court by Jacques Chaoulli, a Montreal family doctor who argued his own case through the courts, and George Zeliotis, a chemical salesman who was forced to wait a year for a hip replacement while he was prohibited from paying privately for surgery.

Chaoulli and Zeliotis lost in two Quebec provincial courts before the Supreme Court decided to take their appeal.

There was no immediate impact on the national system outside Quebec, since the justices split by a vote of 3-3 on the question of whether the Quebec ban on private medical insurance violated the Canadian Charter of Rights and Freedoms, Canada's bill of rights, as the two plaintiffs contended.