The Ontario government’s announced intention to terminate all coverage of unexpected medical emergencies for residents travelling out of the country as of October 1, 2019 appears to be a clear violation of the Canada Health Act.
But that has not prevented the Ontario government, and all other provinces and territories, from short changing their own travellers for years by paying foreign hospitals absurdly low reimbursements for taking care of them when they travel out of the country.
Ontario has been paying up to $200 CAD per day per patient in a standard room, $400 in intensive care, and $50 CAD for an outpatient visit—leaving it to private travel insurers to pay the great bulk of remaining costs (usually well north of 90 percent).
And though the Ministry of Health and Long Term Care (MHLTC) contends that the termination of the OOC program will have no impact on 99.5 percent of Ontarians, studies from the Conference Board of Canada show that only 72 percent of Ontarians bought travel insurance on their last OOC trip (64 percent in the 19 to 34 year age group), and in the first 11 months 0f 2018 Canadians as a whole made more than 31 million trips out of the country.
Let’s look at the Canada Health Act, which is federal legislation that sets five specific conditions individual provinces must meet in order to qualify for federal transfer payments to their health care services (Medicare) program.
Public Administration. It must be administered by a public, non- profit agency accountable to government .
Comprehensiveness. All necessary health services must be insured.
Universality. All residents are entitled to same level of care
Portability. Residents moving or travelling to another province must remain covered by their home province; this also applies to residents who leave the country.
Accessibility. All insured persons must have reasonable access to care—and all physicians, hospitals… must be provided reasonable compensation for the services they provide.
For many years the Canadian Snowbird Association has challenged the provinces to live up to the CHA mandate and provide at least the same level of payment to out-of-country hospitals treating Canadian travellers as those same services would cost at home. And it has also challenged the federal government to penalize (which it has a right to do) those provinces that don’t conform to the deal.
Alas, to no avail.
Yet here is how the federal government itself defines the portability requirement. https://https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act-frequently-asked-questions.html#a9www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act-frequently-asked-questions.html#a9
“While travelling within Canada, the portability criterion of the Canada Health Act requires that insured hospital and physician services are covered at host-province/territory rates. When outside the country, coverage is required to be at home-province/territory rates. As a result, health care services received abroad may not be fully covered by a provincial or territorial health insurance plan. For that reason, it is highly recommended that you purchase private insurance before departing Canada, to ensure adequate coverage.”
For Ontario to have been in compliance with that criterion all these years, one would have to believe that it only cost Ontario hospitals between $200 (CAD) to $400 CAD per day to care for their patients. (PS: British Columbia pays only $75 CAD per day in hospital and $50 for an outpatient visit for its OOC share and Alberta $100 CAD).
If provincial governments consider that fair recompense, how is it that foreign visitors to cities like Montreal, Toronto, Calgary or Vancouver are charged well in excess of $5000 per day for their hospital care-whether they have insurance or not?
Though this reimbursement inequity has been most acutely felt by snowbirds who spend long periods of out of Canada each year, the weekend traveller across the border, the sports fan attending a ballgame in Boston or Cleveland, and the one-day shopper are all in the same boat in that their respective government is now prepared to cut them out of coverage they have paid for all of their adult tax-paying lives.
And we must ask, if Ontario gets away with completely snubbing the Canada Health Act without federal redress or consequence, why not other provinces or territories? Let’s see how long it takes.
It’s true that Canadian travellers—even short-term border crossers—have a well-founded respect for private travel insurance when leaving the country, and that’s only fair given that medical care is expensive no matter where one travels. But with the elimination of even this marginal responsibility under the terms of the Canada Health Act, private travel insurance rates must certainly rise to cover for the government withdrawal of any payments to foreign health care providers.
Some private insurance sources estimate the rise as anywhere between 7 percent and 15 percent.
In our next post we will report on the various processes travel insurers must deal with in helping their clients before, during and after they return from any trips.
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