Out-of-country OHIP dilemma won’t be easy to solve

Is Premier Doug Ford right to end the Out-of-Country Travellers Program? Should other provinces do the same? Or should they increase their coverage for health claims outside of Canada? The answer is far from simple.

Ending the program would supposedly save nearly $12 million. The program pays up to $400 per day for ICU care — unchanged for 20 years. Some 40,000 Ontarians travel outside of Canada each year and require health services; 90 per cent already obtain private health insurance.

Ontario has been quite generous compared with other parts of Canada. Most pay up to the rate physicians receive in that province. As to the maximum paid for hospital care, Alberta and Quebec pay up to $100 per day and B.C. only $75.

However, some people have severe preexisting illnesses. Others may have changed the dose of their medications within three to six months of travelling so may not qualify for travel insurance.

Over 80 per cent of claims involve care in the United States. Much emphasis is placed on the fact that the existing OHIP coverage is only a small percentage of potentially catastrophic hospital bills. Yet overlooked is that not all of the Canadians who leave on business or vacation travel to New York, Florida, California or European cities where medical and hospital charges are much higher than Canada’s.

Recall that half the population of Toronto is foreign-born. Many residents come from South Asia, where the prevalence of diabetes and early cardiac disease is high. Yet many of these new Canadians may actually travel to visit relatives and friends in India, the Philippines, China, Mexico or other countries in which daily hospital charges are surprisingly low. In many cases, the soon-to-be-cancelled OHIP coverage would have been sufficient to cover most or all of these bills.

There is another unintended consequence: If this loss of coverage dissuades new Canadians from visiting relatives back home, some may instead ask their parents and grandparents to come for a prolonged stay in Canada. Many of these elderly patients have pre-existing conditions, and may not be adequately insured. This would put an added burden on our own health-care system. It follows that unless Canada required most visitors to have adequate private health insurance, it might make sense for provinces to increase their out-of-country coverage.

Cancellation of out-of-country coverage would indeed violate the Canada Health Act. This could put the federal health minister and the prime minister in a most difficult situation if they are to be fair to all Canadians. Justin Trudeau might possibly intervene. After all, on Feb. 8, he stated: “We have acted in the past when provinces have not aligned themselves with the Canada Health Act.”

However, if he is to be fair and consistent, he should also address Quebec’s long-standing violation of a different part of Section 11 of the Canada Health Act. That province pays only its own rate when its residents receive medical care in another province, although the CHA indicates that the host-province rate is to apply.

This affects people in west Quebec who seek specialized services in Ottawa and Quebecers who are treated for unexpected accidents or illnesses while on vacation or a business trip in another province or territory. It also impacts Quebecers during the first three months after a permanent move to another part of Canada. Many have pre-existing conditions that require monitoring. They may need to see a physician in their new province for prescription renewals, blood work, X-rays or for an unexpected health problem. Sadly, they are only “covered” by a Quebec health card that few doctors accept. Most are required to pay out-of-pocket, and then wait weeks or months for partial reimbursement from the Quebec government.

Trudeau should not criticize the Doug Ford government if he is unwilling to penalize Quebec Premier François Legault for his own chronic violation of the CHA. People deserve to be treated equally on both sides of the Ottawa River.

Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association. he views here are his own.