The pandemic and the Canada Health Act
Saskatchewan, is now the epicenter of the pandemic in Canada. In October it had the most residents per capita in ICU beds than any other province at any point in the pandemic. The Canadian Armed Forces have been sent in and by October 31, at least 24 patients had been transferred to ICUs in Ontario.
Also in June, Manitoba suddenly had the highest rate of new cases in North America. It sought assistance from the Canadian Armed Forces, requested surplus vaccines from the United States, and transferred 51 patients to Ontario, two to Saskatchewan, and two to Alberta.
This is made possible by the portability provisions of the Canada Health Act. For out-of-province transferred patients, hospitals in Ontario receive, above their global budget from OHIP, a daily ICU rate that is quite variable - $4,653 at University Health Network, Toronto, $1,713 at Hamilton General Hospital, and $4,848 at the Ottawa Hospital. This is ultimately reimbursed by the home province or territory of the patient.
Quebecers are fortunate to be part of Canada. For example, Health Sciences North in Sudbury charges “non-residents of Canada” such as Americans $8,762 per day in the ICU; the Ottawa Hospital charges $7,275. This does not include physician fees.
In contrast to Europe, Canadians can freely go to another province or territory to seek treatment. This occurs frequently for West Quebec patients. The European Health Insurance does not cover costs if one is traveling for the purpose of obtaining medical treatment, and does not guarantee free services.
In the Canada Health Act, because of a reciprocal billing agreement, signed by all territories and provinces and most provinces, physicians can bill OHIP or their own provincial health plan, receive their normal fee, and their own ministry of health then collects from that of the patient. Recall that the CHA was passed unanimously in 1984; thus all Quebec MPs voted for it.
Yet Quebec has continued to violate the CHA. Its patients must usually pay the MD directly and after many weeks receive partial reimbursement from their own province. All federal health ministers have ignored this problem. Justin Trudeau made no mention of this in his December 2019 mandate letter to former Health Minister Patty Hajdu.
New Federal Health Minister, Jean-Yves Duclos is from Quebec City. As a lasting legacy to his fellow Quebecers, he should encourage Christian Dube, Quebec's health minister, to sign the Reciprocal Medical Billing Agreement.
I urge Justin Trudeau to include this issue in his mandate letter to Jean-Yves Duclos,- a symbolic but concrete action that would benefit his constituents and promote national unity. As a Toronto Star editorial concluded, “Trudeau has now set the table for his third term in office. As usual, he scores high on symbolism, but the record is still to be written on substance.”
Charles S. Shaver, MD