MANY “snowbirds” may soon be grounded because of inadequate health coverage outside of Canada. As the federal election approaches, many people will also be making plans for their winter vacation. Yet, worsening drug shortages now cause many to fail to quality for private travel insurance.
Each fall, patients come to my office to fine-tune their medications. Often, when I am about to increase the dose or add a new medication for better control of pre-existing illnesses, patients will remark that they plan to leave for a southern destination in a month or two.
Even a change in dose of medications could invalidate private travel insurance, and certainly a substitute to a similar drug in the same family would do so. Thus a large group of persons — those who have been stable for years on various medications — face possible loss of insurability.
This does not just affect “snowbirds” going to Florida, Arizona or Mexico. Many new Canadians wish to visit friends and relatives back home. Also, a number of fairly young Canadians now have diabetes mellitus, hypertension, lipid disorders, hypertension, and overt heart disease for which they take multiple medications. Yet many of these drugs may become suddenly unavailable.
For many months, well-established drugs have been placed on “backorder” for an unknown period of time. This involves drugs used in cancer therapy as well as several for hypertension, heart failure, diabetes mellitus, heartburn, tuberculosis, and seizures. Is this due to increased global demand, a lack of active ingredients, contamination issues, or vague manufacturing problems, or simply a decision to stop making an unprofitable drug? No one will say.
According to Kelly Grindrod, 1,800 of 7,000 prescription drug products are shorted. A substitute drug in the same family may still have quite different side-effects and reduced efficacy. Moreover, a forced change in medications within three months of travelling can make patients “unstable” in the eyes of insurance companies. Yet patients cannot instead rely on government health insurance for adequate coverage outside of Canada.
The Canada Health Act states that “if insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.” However, for hospital care outside Canada, British Columbia still pays only $75 per day; Alberta, Saskatchewan, Quebec, and New Brunswick pay $100. Until Jan. 1, Ontario will pay $200-400 per day.
Most provinces, recognizing that these are mere token amounts, flippantly advise persons to purchase private travel insurance; this will become increasingly difficult for those whose drugs are switched due to backorders — a real “catch-22” situation.
The Canada Health Act annual report for 2017-18 states: “For all jurisdictions except Prince Edward Island and the three territories, the per diem rate for out-of-country services appear lower than the home province or territory rate, which is contrary to the requirement of portability criterion of the CHA (Canada Health Act).” Financial penalties for violations of extra-billing and user fees are “mandatory,” whereas those for other violations such as portability are only “discretionary.” The report admits, “To date the discretionary penalty provisions of the Act have not been applied.”
Canadians should demand that health minister Ginette Petitpas Taylor investigate the cause of worsening drug shortages and find solutions. Dr. Jacalyn Duffin, creator of canadadrugshortage.com, recently said: “Canada should be standing up and leading the world in investigation to figure it out.”
In addition, after many years of inaction, Petitpas Taylor should finally ensure that all Canadians receive at least the health coverage outside their country that is clearly required by the Canada Health Act.
Enforcing the Canada Health Act will likely cause provinces to demand increased federal health transfer payments. Hence when the health ministers next meet, updating and amending the act should be on the agenda so as to make health delivery more fiscally sustainable.
By the Oct. 21 election, the SNC Lavalin affair and Justin Trudeau’s broken promises on balancing the federal budget, voting reform, the amount of the carbon tax refund, and avoidance of omnibus bills will probably seem less important to than health access issues. The problems described above, if anything, will become more relevant as winter approaches and likely even more drugs are suddenly placed on backorder. Many persons may be shocked to discover that they are deprived of spending a few weeks in the south due to lack of adequate health coverage outside Canada.
All politicians should realize that most of these affected persons do vote.
(Ottawa physician Charles Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is past-chair of the Ontario Medical Association section on general internal medicine. The views here are his own.)