Health care must be portable for all Canadians

“Why is the federal government letting Quebec get away with this violation, when it was so inflexible in the issue of extra-billing?” then federal health critic David Dingwall asked in May 1989.

Unfortunately, when he became health minister, he ignored the problem. So have all federal and provincial politicians. They have immediate, red-carpet health care and are not personally affected; only average working class persons — especially from Quebec — are.

This is not merely a matter of financial inconvenience. It can cause real hardship and adversely affect outcomes. A 2010 article in the Globe and Mail described a man living across the river from Ottawa who developed colon carcinoma. There was a year wait for a colonoscopy in West Quebec, and the Ottawa anesthetist refused to see him because he had Quebec insurance. He therefore waited several additional months until surgery could be done in Montreal. Sadly, by now he had extensive lymph node metastases, required high dose treatment, developed bowel obstruction and other complications, and died a couple of years later in great pain.

Quebecers still enjoy portability for hospitals in other provinces, but not for physician services. Quebec residents seeking medical treatment in another province usually find the MD refuses to accept their provincial health card. They are billed directly and later partially reimbursed. Those who permanently move to another province are “covered” for the first three months by Quebec insurance. Should they need to see a physician for diagnostic tests, prescription renewals, etc., they must pay out-of-pocket until their new provincial insurance is in effect.

When the recent 10-year bilateral agreement on health transfers was signed, Quebec’s “distinct” character was recognized as well as the “principle of asymmetry” — thereby legitimizing its ability to accept federal funds without adhering to the five principles of the Canada Health Act, including portability.

Healthcare is a provincial matter. But which province — is it that of the patient, or that of the treating physician? At present, Quebec residents fall through the cracks. Surely it is time for Ottawa to intervene.

As premier of Manitoba — the only province not yet to sign a bilateral deal with Ottawa — Brian Pallister may be the only person with the leverage to force the federal government to finally make medical care fully portable. Quebec has persistently refused to sign an interprovincial agreement covering medical care. The obvious solution is for the federal government to pay all Canadian physicians directly for care rendered to a patient outside his/her own province. If Premier Pallister included this as part of his bilateral agreement, the same deal should apply for all other provinces and territories.

Precedents exist. MDs are paid by Ottawa for treating federal prisoners and for refugees prior to obtaining their provincial health insurance coverage. This was, until recently, the mechanism of payment for members of the RCMP.

Using data from the Canadian Institute for Health Information, I estimate that this proposal would cost about $175 million, or 0.7 per cent of the total amount paid for physician services across Canada. Consider that Ottawa is spending $500 million for the 150th anniversary of Confederation.

In this, our 150th year as a nation, all Canadians should be encouraged to visit different parts of the country and familiarize themselves with their distinct cultures and people. Those with pre-existing illnesses should not be deterred from travel for fear that they might face unaffordable upfront medical charges in another province.

Many years ago, Newfoundland and Labrador Premier Clyde Wells stated, “Being a Canadian must mean that a citizen can go to any province and still be a full Canadian.” Recently, Ontario Health Minister Eric Hoskins, when discussing patients referred to a LHIN different than the one of their residence said, “There are no boundaries in terms of access to medicine.” If only politicians had the will to make this true for our entire nation.