August 23rd, 2019

National Affairs: Ottawa is finally defending out-of-country medical costs

By Medicine Hat News Opinon on August 5, 2019.

It took a while. But Canada’s Liberal government has finally challenged Premier Doug Ford’s patently illegal plan to cancel emergency medicare coverage for Ontarians travelling abroad.

Federal Health Minister Ginette Petitpas Taylor started the ball rolling last week by officially issuing what, under the Canada Health Act, is called a “notice of concern” to Christine Elliot, her provincial counterpart in Ford’s Progressive Conservative government.

Petitpas Taylor said she was “concerned” by the Ford government’s abrupt decision in April to cancel the province’s out-of-country travellers program, which provides some OHIP coverage to Ontarians who suffer medical emergencies while temporarily journeying outside Canada.

The federal health minister noted correctly that the Ontario government’s decision, which is due to take effect Oct. 1, was “inconsistent” with the Canada Health Act, the law governing medicare. That law sets out the criteria that provinces must meet to be eligible for federal medicare funding.

One criterion is portability – the requirement that provincial medicare plans cover residents who are temporarily travelling elsewhere in Canada or abroad.

The law says that provincial plans must reimburse those who require emergency medical care outside Canada “on the basis of the amount that would have been paid by the province for similar services rendered in the province.”

Simply put, that means if you break your leg travelling abroad, you may not be reimbursed by your provincial medicare plan for all of your medical costs. But you should be reimbursed for what it would have cost to get the leg fixed at home. As Petitpas Taylor notes, if Ontario abandons out-of-country coverage, it would be the first province to do so.

Ontario’s case for contravening the Canada Health Act does not stand up to scrutiny. First, the province argues that OHIPs out-of-country payments are so puny as to be virtually worthless.

Indeed, given that they haven’t changed in 20 years, they are puny. An Ontarian injured abroad will be reimbursed by OHIP at the rate of $200 a day for in-patient hospital care ($400 for intensive care), $210 a day for renal dialysis and $50 a day for outpatient care. None of that will get him or her very far – particularly in the high-cost U.S. health system

But the answer is not to kill the out-of-country program. Rather it is to ensure that rates paid by that program better reflect, as the Canada Health Act demands, the real cost of medical care in Ontario.

What is the real cost of medical care delivered in Ontario? The answer is not simple. But we can get some idea by looking at what hospitals in this province charge non-residents who are not covered by Canadian medicare.

Ottawa’s Queensway Carleton Hospital, for instance, posts its fees online. It charges $930 to a non-resident visiting its emergency department and $3,495 more if day surgery is required. Physicians fees are on top of this as are lab tests, X-rays and scans.

The hospital charges non-residents $2,990 a day for a bed in a ward and $6,000 a day for one in its intensive care unit.

These costs don’t match exorbitant U.S. levels. But they are closer to reality than the pittances provided for by Ontario’s out-of country program.

Ontarios second defence for its decision to scrap out-of-country coverage is that, at $2.8 million a year, the cost of administering a program that provides only $9 million in benefits is too high.

I’m not sure why this matters so much for a government that spends more than $160 billion annually, but it, too, is a backward argument. If the current out-of-country payment system were more realistic, it would provide far more than $9 million in benefits at roughly the same administrative cost.

Where does this brewing federal-provincial conflict go? Petitpas Taylor has 90 days to issue a report.

After that report is filed, the federal cabinet has the authority to financially penalize Ontario for failing to live up to its Canada Health Act obligations.

All of this takes place smack dab in the middle of the federal election campaign. Will Justin Trudeau’s Liberals run on a promise to protect medicare from the depredations of Conservatives like Ford?

They’ve done it before.

Thomas Walkom writes on national affairs for Torstar Syndication Services.

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