In late October, there will be a federal election. Quebecers and other Canadians will likely care less about the ethical issues in the SNC Lavalin affair, and more about jobs, personal finances, and even how to cope with the return of winter. Many people will be making plans for their winter vacation. Yet especially in battleground areas such as Ontario and Quebec, a high percentage of these people will be voting.

Each fall a number of 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 diabetes mellitus, hypertension, etc., patients will remark that they are planning to leave for Florida, take a cruise or go to other out-of-country destinations in a couple of months.

Even a change in dose of medications could invalidate private travel insurance, and certainly a change to a “close-cousin” in the same family would do so. I usually simply advise them to adhere more strictly to dietary restrictions until they return to Canada. Now a larger group of persons– those who have been stable for years on medications – face possible loss of insurability.

For many months, well-established drugs have been suddenly 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, 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. Health Canada reports that there are currently 1848 drug shortages and 65 anticipated shortages.

A substitute drug in the same family may still have quite different side effects and reduced efficacy. A forced change in medications within three months of travelling can be economically disastrous if it makes patients “unstable” in the eyes of insurance companies. The Doug Ford government plans to cancel out-of-country health coverage as of January 1 except for renal dialysis. Patients are urged to simply purchase private travel insurance. But this will become increasingly difficult for many.

Until coverage is cancelled, Ontario pays $200 per day and up to $400 for ICU care. Yet this was more generous than many provinces. British Columbia still pays only $75 per day, and Alberta, Saskatchewan, Quebec, and New Brunswick pay $100.

By comparison, for someone visiting from another province or territory, a community hospital in Ottawa receives $1010 for a standard room and the Ottawa hospital receives $1958.

The Canada Health Act Annual Report 2017-2018, states the following: “If insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.”

Of interest is that buried in the report is this correct statement: “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.” Sadly, whereas financial penalties for violations of extra-billing and user fees are “mandatory,” those for other violations such as portability are only “discretionary.” The report continues, “To date the discretionary penalty provisions of the Act have not been applied.”

All Canadians — but especially those planning to leave the country on business or vacation — should demand that the Federal Health Minister investigate the cause of worsening drug shortages and find solutions. In addition, after many years of federal inaction, she should finally ensure that all Canadians receive at least the health coverage outside their country that is clearly required by the Canada Health Act. This will likely provoke demand by the provinces for increased federal health transfer payments. Hence when the federal, provincial, and territorial health ministers next meet, updating and amending the CHA should be on the agenda so as to make health deliverymore fiscally sustainable.

By the October 21 election, the Lavalin affair, Justin Trudeau’s pledge to balance the federal budget will likely be far less important to most Canadians than health issues. The problems described above if anything will become increasingly relevant as winter approaches and quite likely even more drugs will be suddenly placed on backorder. In this “Catch-22” situation, many persons will be deprived of the ability to spend a few weeks in the sun due to lack of adequate health coverage outside Canada.

Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.

The views here are his own.

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