TORONTO – You’re driving to Florida and you get into an accident on I-95 in New York State.
You’re rushed to hospital.
You didn’t buy travel insurance. Will OHIP pay for your stay in a U.S. hospital?
The answer is yes. And no.
The Ministry of Health will pay for “very limited funding for a certain range of medical services,” according to a spokesman for Health Minister Eric Hoskins.
The government’s website says you are “strongly advised” to purchase additional health insurance every time you leave Canada.
Out-of-country healthcare has become contentious, as families across the province find they can’t get funding for life-saving surgeries that are only available south of the border.
Very quietly, changes have been made to OHIP over the years that have sharply eroded the number of out-of-country services OHIP will pay for.
Prior to Oct. 1, 1991, you could go anywhere in the world and get healthcare — without prior approval. Now you must get pre-approval — or forget it. That approval is very difficult to obtain. You must prove no surgeon can provide the care here.
The changes were introduced in an attempt to prevent medical tourism.
Back in 2010, the Health Services Appeal and Review Board (HSARB) ordered OHIP to pay an estimated $200,000 for neurosurgery in Phoenix for an Ontario teen suffering from a rare brain lesion. While the surgery was available in this province, his family sought a doctor that had the best outcomes — and that was in the U.S.
Ministry of Health numbers show the dollar figure for out-of-country care has plummeted since then. And while the ministry claims that’s all down to the fact that the government is now providing care in this province for conditions that once had to be treated in the U.S, the fact is it’s much harder to get treatment out of country because the rules have changed.
“The Ministry of Health continues to increase or create new capacity inside Ontario for a number of services that have been routinely funded through the out-of-country prior-approval program in the past,” Shae Greenfield told me by e-mail.
He said an Ontario-based bariatric program, a residential eating disorder treatment program and investments in cardiac and cancer capacity, have reduced this province’s reliance on U.S. treatments.
Costs decreased from $127.9 million in 2008/09 to $56.4 million in 2013/14, Greenfield said.
Meanwhile, the ministry routinely refuses to pay for out-of-country care for people like little Alesandro Ciampa. Born with born with spastic cerebral palsy, Alesandro, 7, needs specialized “life-changing” surgery at the St. Louis Children’s Hospital in Missouri because there’s no surgeon who performs the surgery here. The government is balking at paying for it.
The same is true of Ehler-Danlos Syndrome patients such as Erika Crawford of Brantford. Her family has mortgaged their house to pay the hundreds of thousands of dollars for life-saving surgery in Maryland. OHIP won’t pay. If you have a condition for which there’s no treatment in this province, don’t look to the government for care. Have a bake sale. Sell your house. Create a gofundme.com account.
Look, public healthcare was never meant to pay for an all-you-can-eat buffet of round-the-world medical tourism. But it should pay for care that’s not available in this province. People like Erika and Alesandro are paying a human cost for those lower numbers. And that’s a terrible shame.
Out-of-country care info:
- The health ministry could not provide the cost of emergency care outside Ontario and those numbers are not included.
- The ministry could not provide details of what the $135 million spent on “genetic testing,” paid for last year.
- The ministry could not provide details of which U.S. hospitals were paid to provide treatment.
- OHIP will pay only for insured, emergency out-of-country health services that are rendered to an insured person. To qualify as an “emergency”
- The treatment must be medically necessary.
- The treatment must be related to an illness, disease, condition or injury that is: acute and unexpected, arose outside Canada and requires immediate treatment.
Total expenditures for out-of-country care:
2007/08 – $101.3 million
2008/09 – $127.9 million
2009/10 – $121 million
2010/11 – $54.4 million
2011/12 – $33.5 million
2012/13 – $39.1 million
2013/14 – $43.5 million
2014/15 – $56.4 million
2014/15 (Q1*) – $16.2 million
Source: Ontario Ministry of Health and Long-Term Care