Should Quebec follow the lead of Ontario? Premier Doug Ford recently threatened to end government health coverage for emergency services outside of Canada. He faces a $10.3 billion deficit, and doing so would supposedly save nearly $12 million. Should other provinces do the same? Or should they increase this coverage and follow the example of PEI? The answer is far from simple.

The maximum per day in Ontario is $400 – unchanged for 20 years. Newfoundland and Labrador pays $350 per day for a stay in a community hospital and $465 in a tertiary one. Manitoba pays up to $570, Quebec, Saskatchewan, New Brunswick, and Alberta $100, and British Columbia only $75. Most government health plans reimburse only the rate that physicians would have received in that province. All urge travelers to obtain private health insurance.

However, many cannot qualify or afford it due to severe pre-existing illnesses or a change in the dose of their medications within a few months of travelling.

Provincial health plans emphasize that they cover only a small percentage of potentially catastrophic hospital bills. Yet many overlook that not all of the Canadians who leave on business or vacation travel to the United States or California or Europe where medical and hospital charges are indeed much higher than in our country.

Many new Canadians travel to visit relatives and friends in India, the Philippines, China, Mexico, Lebanon, or other countries in which daily hospital charges are surprisingly low. In many cases, their existing provincial health coverage would have been sufficient to cover most or all of these bills. This would permit many of these persons to travel freely with adequate government coverage not dependent on previous good health. Their physicians could then freely fine-tune their diabetic or antihypertensive medications shortly before they leave Canada.

There is another potential problem: If a loss of this coverage dissuaded new Canadians from visiting relatives back home, some might instead ask their parents and grandparents to come for a prolonged stay in Canada. Many of these elderly patients have pre-existing conditions, and likely would not be adequately insured. This would put an added burden on our own healthcare system.

Ontario NDP Health Critic France Gelinas has written to Federal Health Minister Ginette Petitpas-Taylor, asking whether Ontario might be violation the Canada Health Act. Penalizing Ontario could put Petitpas-Taylor and the Prime Minister in a most difficult situation.

Justin Trudeau might possibly intervene. After all, on February 8, he stated (Ottawa Citizen), “We have acted in the past when provinces have not aligned themselves with the Canada Health Act.”

However, if he is to be consistent, he should also address Quebec’s longstanding violation of a different part of Section 11 of the Canada Health Act. 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. As a result, few MDs in Ontario or elsewhere in Canada will accept a Quebec medicare card.

This affects persons in West Quebec who seek specialized services in Ottawa and Quebecers who are treated for unexpected accidents or illnesses while on vacation or a business trip in another province or territory. It also impacts Quebecers during the first three months after a permanent move to another part of Canada. Sadly, they are only “covered” by a Quebec health card that few MDs will accept. Most are required to pay out-of-pocket, and then wait several weeks or months for partial reimbursement from the Quebec government.

Trudeau should not criticize the Doug Ford government if he is unwilling to urge Quebec premier Francois Legault to also obey all parts of the CHA.

Of interest is that PEI is the only province to fully comply with the Canada Health Act. For emergency care outside Canada, it pays $1169 for a standard room and $2712 for the ICU, ie the “interprovincial rate.”

Premier Ford has “opened a Pandora’s box.” He has inadvertently drawn attention to the longstanding, flagrant violation of out-of-Canada hospital coverage by all provinces except for PEI. He should immediately change the CHA or enforce it. After 33 years, it is really time for Ottawa to update and modernize this legislation. Our 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 a new, amended CHA should be enforced equally on all provinces and territories.

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