Make visitors get some health insurance
Our overburdened system can’t support everyone, says Dr. Charles S. Shaver.
Should all visitors to Canada have health insurance?
To answer this question, consider two main groups: The first is persons visiting the country for only a few days. The second is relatives staying for weeks or months, many with pre-existing conditions that make it difficult to buy insurance.
The asylum-seekers and illegal migrants entering mainly via Quebec are covered promptly by the Interim Federal Health Program (IFHP). Yet Canada does not require medical insurance for those on a visitor visa. Many other countries do, including United Arab Emirates, Aruba, Belarus, Bulgaria, Cuba, the Falkland Islands, Latvia, Slovakia and Russia, and possibly soon Thailand. Medical insurance is required for those obtaining a visa to the 26 countries in the Schengen zone of Europe.
An RBC survey found that 75 per cent of Canadians travelling abroad planned to buy extra travel insurance. This is likely not true for visitors to this country.
The number of overseas tourists to Canada may increase by more than six per cent this year. When cannabis is legalized and eventually sold in private stores in much of Canada, there may well be an influx of “weed tourists.”
More than ever, health insurance is needed to cover tourists injured unexpectedly in auto accidents, fires, floods, bridge collapses and other disasters, and to help in the remote event of random shootings and other acts of terrorism. Consider these examples: Toronto has seen 73 homicides this year — seven more than in all of 2017. A crash of a bus on Highway 401 east of Kingston in early June killed three and injured another 34 Chinese tourists. In early August, a German tourist was shot in the head near Calgary.
Meanwhile, because of the recent dispute with Saudi Arabia, nearly 800 residents and fellows across Canada are required to leave Canada when they find a new training program. Each medical school here had been receiving $100,000 per person. Saudi medical trainees made up 18 per cent of international medical graduates in this country. Dr. Frank Rybicki, chair of the department of radiology at the University of Ottawa, termed this loss “staggering.” The impact will be most severe in Montreal, where 20 per cent of residents and fellows are Saudi.
The Canada Health Act precludes physicians from charging wealthier patients more to make up for those who are uninsured. Hospitals and MDs can hardly provide free care to visitors; they should all have health insurance.
Unfortunately, there are limits to such insurance. It does not cover routine office visits to monitor diabetes mellitus, hypertension, et cetera. It also does not cover complication of pre-existing illnesses, especially if medications have changed within the previous three to six months.
Ottawa, Toronto and other larger cities are becoming increasingly multicultural. Many new Canadians may try to arrange prolonged visits for parents, grandparents and other relatives, but cannot obtain adequate insurance for them due to their pre-existing diabetes, cardiac disease, etc. Recall, however, that those who sponsor relatives are legally responsible for their support and for any hospital or physician bills that they incur. What can be done to be fair to sponsors as well as to MDs and hospitals?
Possibly a company such as Medavie Blue Cross (which handles the IFHP, RCMP and the military) could include these high-risk persons, with co-ordination by Ottawa. Visitors would be covered for critical illnesses requiring in-hospital treatment, but in order to contain costs, routine office visits and elective surgery would have to be excluded, and there would be a deductible. Relatives of these visitors would be charged a significant premium per week. This might mitigate the cost and also encourage them to minimize the length of stay of relatives — hence reducing the likelihood that a severe complication might occur.
It is the federal government that allows all temporary visitors to enter this country. It therefore owes health providers and hospitals the assurance that they will be fairly and promptly remunerated should any visitor require unexpected medical or surgical treatment while here. When the House of Commons is back in session later this month, it should discuss and resolve this problem. Ottawa physician Dr. Charles S. Shaver is chair of the section on General Internal Medicine of the Ontario Medical Association. These views are his own.