Time to discuss health insurance for tourists
It’s not fair that the Canadian system has to pay when visitors need care
Every time an uninsured visitor does not pay for their treatment in one of our public hospitals, taxpayers foot the bill.” — Brad Hazzard, New South Wales (Australia) health minister
Brad Hazzard was referring to $30 million in unpaid medical expenses per year, and is proposing that all tourists to Australia be required to have health insurance. Should Canada do the same?
Increasingly, such insurance is necessary to cover tourists unexpectedly injured in auto accidents, floods, fires, bridge collapses, and in the remote event of shootings and other acts of terrorism.
Proof of health insurance is required by Abu Dhabi and Dubai, Aruba, Belarus, Bulgaria, Cuba, the Falkland Islands, Latvia, Slovakia and Russia, and possibly Thailand in the near future. It is mandated to obtain a visa to the 26 countries in the Schengen zone of Europe.
The number of overseas tourists to Canada may increase by 6.7 per cent this year. Total visitors to Toronto increased by 3.6 per cent; this included a jump in those from Mexico by 72 per cent, India by 31 per cent, Brazil by 23 per cent, and China by 9.1 per cent.
Certainly, the need for travel health insurance already exists in Canada. A bus crash on Highway 401 east of Kingston in June killed three and injured 34 Chinese tourists. A German tourist was shot in the head near Calgary in early August. Toronto now has a higher homicide rate than does New York City, and has witnessed a greater number this year than in all of 2017.
Because of the Canada Health Act and Ontario Bill 94, physicians here cannot charge wealthier patients more to compensate for those who are uninsured. With the recent dispute between Ottawa and Saudi Arabia, Canadian medical schools are losing $100,000 for each medical resident or fellow forced to leave our country. Hence, both hospitals and MDs are hardly in a position to provide free care to visitors; all should be urged to buy health insurance. Possibly, it should even be mandated by Ottawa.
Sadly, such insurance does not cover routine office visits nor complications of a pre-existing illness. The solution is much more complicated.
Many of our larger cities are now multicultural. Many new Canadians may wish to arrange for prolonged visits for parents, grandparents, etc. Yet pre-existing diabetes, cardiac disease, etc. may preclude buying adequate private insurance. Sponsors are legally responsible for medical bills incurred by their relatives. How can we be fair to the sponsors, temporary visitors, but also to physicians and hospitals?
Possibly, Medavie Blue Cross (or a similar company) — which handles the Interim Federal Health Program for refugees, as well as benefits for the military and the RCMP — could expand coverage to include these long-term visitors, under the supervision of Ottawa, with premiums to be paid by the sponsors. To reduce costs, there would be a deductible, and routine office visits and elective surgery would be excluded. It would, however, cover critical illnesses requiring in-hospital treatment. These might include a heart attack, stroke, severe infection, acute congestive heart failure, fall with a fracture, etc.
Sponsors would pay a significant premium per week. This would encourage them to keep the length of stay of relatives in Canada to a minimum; this would minimize the chance that such complications might occur.
Ottawa permits all temporary visitors to enter Canada. It follows that it now has an obligation to health providers and hospitals to ensure that they will be fairly and promptly remunerated should any visitor need unexpected medical or surgical treatment in this country.
The House of Commons resumes sitting on Sept. 17. Members of Parliament should discuss and resolve this increasing problem.
Ottawa physician Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is chair of the section on general internal medicine of the Ontario Medical Association. The views here are his own.