PREMIER Doug Ford plans to cancel OHIP coverage outside of Canada. With high administrative costs for the program and a nearly $12 billion provincial deficit, such action might have initially seemed reasonable. However, this would violate the Canada Health Act. Furthermore, because of several unintended consequences, one could argue that Ontario and other provinces should instead increase this coverage and follow the example of Prince Edward Island (P.E.I.).

For emergency care outside the country, most provinces pay up to the rate that their own physicians would have received. Ontario pays up to $400 per day for care in an intensive care unit (ICU) but otherwise $200. 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 — in essence, the “interprovincial rate.”

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. New Brunswick, Quebec, Saskatchewan, and Alberta pay up to $100 per day, Nova Scotia $525, Manitoba $570, but British Columbia only $75.

All urge persons to obtain private insurance. However, it is not so simple.

Some persons 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 now cover only a small percentage of these potentially catastrophic hospital bills. Yet not all of the Canadians who leave on business or vacation travel to the U.S. or Europe.

Many residents of larger Canadian cities come from third world countries. Thus many of them may travel to visit relatives and friends in countries in which daily hospital charges are surprisingly low.

Bill Frezza recounts (Foundation for Economic Education, July 10, 2017) how his wife spent four days in a Beirut hospital in Lebanon that included two days in the ICU, an MRI and a CT scan. The total hospital bill was one-tenth of what it would have been in Boston. 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, anti-hypertensive, and heart failure medications shortly before they leave Canada.

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 healthcare system.

All provinces, except for P.E.I., have therefore 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 Feb. 7 Justin Trudeau stated: “We have acted in the past when provinces have not aligned themselves with the Canada Health Act.”

Trudeau should enforce the law or change it.

In addition, he should also address Quebec’s longstanding violation of a different part of Section 11 of the Canada Health Act (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 people in southwestern Quebec who seek specialized services in Ottawa and Quebecers who are treated for unexpected accidents or illnesses while on vacation or a business trip elsewhere in Canada. It also impacts Quebecers during the first three months after a permanent 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 several weeks or months for reimbursement. Trudeau should not criticize Doug Ford if he is unwilling to penalize Quebec for its own violation of the CHA.

Ford’s threat to completely cancel out-of-country coverage has inadvertently drawn attention to this widespread noncompliance. Surely, after 33 years, it is time for 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. Then the new CHA should be enforced uniformly on all provinces and territories.

(Ottawa physician Charles Shaver is past-chair of the Ontario Medical Association section on general internal medicine.)

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