The Ontario government is planning to amend Regulation 552 of the provincial Health Insurance Act, to eliminate out-of-country (OOC) medical coverage.
Critics of the Ford government are predictably outraged. But why? Should we really be paying the health bills of snowbirds, cross-border shoppers and other travellers once they leave the country?
To begin with, this program is a joke – it provides a maximum of $400 a day for intensive care or surgical services, and only $50 a day for outpatient services. (Every province and territory has a similar program; half of them are less generous than Ontario, covering as little as $75 daily. No province covers more than $1,500 a day.)
In the United States – the principal destination for Canadian travellers – you would be lucky to get a Band-Aid for 50 bucks in a hospital. If you have a heart attack and require a simple bypass, surgery alone will cost US$40,000. Take a spill hiking and suffer a severe spinal or neurological injury and the bill could easily exceed US$1-million.
What private insurers do – and do quite well – is repatriate travellers as quickly as possible so they will be back in the Canadian health system, where care is “free.”
Anyone who is foolish enough to travel without first purchasing private health insurance faces the prospect of catastrophic medical bills, with or without this program.
The OOC program is also highly inefficient. A lot of time, energy and money is spent making piddling payments: There are about 88,000 claims a year, and the average reimbursement is $127.
Put another way, it costs $2.8-million to pay $9-million in claims and those payments cover less than 5 per cent of travellers’ medical bills.
The Canadian Snowbird Association has objected to this change, fearing that it will increase the cost of private health-insurance premiums by as much as 7.5 per cent.
That’s a legitimate concern but the answer is to call for better regulation of private insurers, or tax breaks for the purchase of insurance, not for the maintenance of a mostly useless public program.
The most compelling argument for maintaining out-of-country medical coverage is that, under the federal Canada Health Act (CHA), “portability” of coverage is guaranteed. The law states that “where the insured health services are provided out of Canada, payment is made on the basis of the amount that would have been paid by the province for similar services rendered in the province.”
Every single province and territory violates that provision of the law, and they have done so for decades.
The CHA is a paper tiger. The portability clause is routinely ignored, especially within Canada. People who live in border towns such as Ottawa and Gatineau are often denied care in neighbouring provinces or, just as bad, asked to pay supplemental fees.
Worse yet, there are services that are not deemed essential under the law that end up costing patients a fortune.
A few times a year there are horror stories of Canadians visiting out of province and saddled with big bills. In February, a Nova Scotia retiree suffering shortness of breath while visiting family in Alberta got a $25,000 air-ambulance bill; last year, an Ontario woman’s heart attack in Nova Scotia cost her $12,000; and, in an infamous 2015 case, an Alberta woman got a $30,000 air-ambulance bill after giving birth prematurely in Northern Ontario.
What these stories remind us of is that you should actually have private health insurance if you plan to leave your home province, let alone the country.
We should be getting our domestic house in order before worrying about travellers.
What the government of Doug Ford has done in this instance is justifiable. Where it erred is trying to ram through the change without consultation.
This could have been a golden opportunity to discuss one of the most important and unaddressed public-policy questions in the country: What is covered by medicare and what isn’t?
Almost 30 per cent of health spending in Canada is paid for privately – either out-of-pocket or with private insurance.
We owe it to ourselves to clearly delineate when private insurance is required – and one of those places is when you travel.
“Know your policy” is a golden rule when purchasing private insurance – know what’s covered, what isn’t, your co-pays and deductibles, and the cost.
The same should be true of public insurance.
What the out-of-country coverage debate has exposed is that when it comes to medicare, our expectations are unrealistic and our ignorance is astounding.