OTTAWA MUST ENFORCE THE CANADA HEALTH ACT
Provinces violating out-of-province payment rules, says Dr. Charles S. Shaver
Will Justin Trudeau enforce or ignore the Canada Health Act?
Ontario Premier Doug Ford plans to totally cancel provincial health coverage outside of Canada. With high administrative costs for the program, and a nearly $12-billion provincial deficit, such action was well-meaning and might have seemed logical.
However, this would violate Section 11 of the Canada Health Act. Furthermore, when one considers several unintended consequences, Ontario and other provinces should instead increase this coverage and follow the example of P.E.I. and the territories.
For emergency care outside the country, most provinces pay up to the rate that their own physicians would have received. P.E.I. follows the requirement of the Canada Health Act and pays $1,169 for a standard room and $2,712 per day in the ICU, ie the “interprovincial rate.” The Northwest Territories reimburses up to $2,741 for a standard room and $9,092 for an ICU bed. Yukon pays up to $2,010 and Nunavut $2,730 daily for all in-patient care. All other provinces pay much less. Newfoundland and Labrador pays a maximum of $350 per day for a stay in a community hospital, and $465 in a tertiary one. Saskatchewan, Alberta, Quebec, and New Brunswick pay up to $100 per day. Ontario pays $200 per day ($400 in ICU). Nova Scotia pays up to $525, Manitoba $570, but British Columbia only $75.
All urge people to obtain private insurance. However, it is not so simple.
Some people cannot qualify for or afford it. They may have severe pre-existing illnesses or have changed the dose of medications within three to six months of travelling.
Most claims involve care in the United States. Provincial governments cover only a small percentage of these potentially catastrophic hospital bills.
Yet not all of the Canadians who leave on business or vacation go to the U.S. or Europe.
Many residents of larger Canadian cities come from Third World countries or China. Thus many of them may travel to visit relatives and friends in these countries, where daily hospital charges are surprisingly low. An increase in out-of-country payments would permit many to travel with government coverage not dependent on previous good health. Their physicians could then fine-tune their diabetic, antihypertensive, and heart failure medications shortly before they leave Canada.
Elimination of even token coverage might dissuade new Canadians from visiting relatives back home. Some may instead ask their parents and grandparents to come for a prolonged stay in Canada. Many have pre-existing conditions and lack adequate insurance. This would then put an added burden on our own health care system.
All jurisdictions except for P.E.I. and the territories have been violating the Canada Health Act for many decades. This puts the federal health minister and the prime minister in a most difficult situation. After all, on February 7, Justin Trudeau stated, “We have acted in the past when provinces have not aligned themselves with the Canada Health Act.” Ontario’s proposed regulatory change takes effect October 1. So before the federal election, Trudeau must indicate whether he will ignore or enforce the entire CHA. To date, he has enforced only parts of the Act on certain provinces.
He should finally deal with Quebec’s long-standing violation of a different part of the CHA. That province pays only its own rate when its residents receive medical care in another province, although the CHA clearly indicates that the host-province rate is to apply.
This affects Quebecers who require medical care elsewhere in Canada or during the first three months after a move to another province or territory. Sadly, all these groups are “covered” only by a Quebec health card that few physicians will accept. Most are forced to pay out-of-pocket, and then wait for reimbursement.
Hence, most provinces have been flagrantly violating part of Section 11 of the Canada Health Act and getting away with it. This topic should be discussed when the premiers meet in Saskatoon on July 9-11 for the Council of the Federation. If provinces and territories are finally required to obey Section 11 of the CHA and pay “interprovincial rates” for out-of-country care, they will likely demand increased federal funding. The Canada Health Transfer now supplies less than 25 per cent of provincial health budgets. Meanwhile, Ottawa faces a current deficit of $19.8 billion.
Ford’s threat to completely cancel out-of-country coverage has inadvertently drawn attention to this widespread non-compliance. Surely, after 33 years, it is time for
All urge people to obtain private insurance. However, it is not so simple.
Ottawa to update, modernize, and amend this legislation. Canada’s health delivery system ranks near the bottom in terms of efficiency as well as patient and physician satisfaction. We should look to other, more successful models in Europe, Taiwan, Australia, and New Zealand. This might reduce the need for provincial and federal funding for health care. Eventually the new, revised CHA should be enforced uniformly on all provinces and territories.