Looking for the cracks in medicare? Try the Ontario-Quebec border

Published Wednesday, Nov. 10, 2010 11:49PM ESTLast updated Thursday, Nov. 11, 2010 7:47AM EST77 comments

At only 26 years old, the Canada Health Act is ailing.

The act guarantees universal health care, setting out key principles of access and affordability – one of which suffers from a serious case of neglect.

Under the portability requirement, every Canadian is entitled to full medical coverage, no matter where he or she lives, and provincial health insurance plans are supposed to be good anywhere in the country.

But that tenet is showing cracks at the Quebec-Ontario boundary. Quebec patients are turned away or pay out-of-pocket for medical services outside their home province, essentially denied portability.

Fair or not, that’s the stinging reality of a creaking medical system – one that Ken Jamieson felt the effects of first hand. In need of a colonoscopy on the advice of his doctor late last year, he was told he would have to wait a year in his hometown of Gatineau, Que., or pay for it at a private clinic. But across the river, a mere 15-minute drive away in Ottawa, it could be performed in about a week.

Mr. Jamieson was turned away, because he was told the anesthesiologist in Ontario wasn’t accepting Quebec patients.

The rates Quebec pays to physicians to deliver medical services are, on average, the lowest in Canada, which means that patients like Mr. Jamieson are refused non-urgent care when they travel to another province, are treated like foreigners, or are among the lucky few who have doctors provide medical services at a discounted rate.

“It’s not what I could call fair,” says Mr. Jamieson, a retired high-school teacher.

The Canadian Medical Association has called on Health Canada to enforce the portability provision of the act. The Harper government, however, doesn’t appear eager to wade into what it deems a provincial matter – especially in Quebec. “Requiring patients to pay up front, and having them seek reimbursement from the covering province or territory, still satisfies the portability criterion of the act, as long as access to a medically necessary insured service is not denied due to the patient’s inability to pay,” said Tim Vail, spokesman for Federal Health Minister Leona Aglukkaq.

Quebec doesn’t believe it’s doing anything wrong, saying it has no obligation under the law to pay the additional fees demanded by physicians in other jurisdictions. A spokeswoman for the Health Minister said the government doesn’t intend to change its mind.

In the midst of all this political mayhem, the lowly patient suffers.

“When we consider that many people spend thousands and thousands and thousands of dollars a year in taxes to go to a system to fund it, it is frustrating for them when they can’t get care. I think it’s more a reflection of a system that’s no longer functioning well,” said Merrilee Fullerton, president of the Academy of Medicine Ottawa.

For life and limb, patients are never denied access to the country’s emergency rooms (there are interprovincial agreements to cover any in-hospital and emergency care). When it comes to non-urgent medical services, that’s where the system’s failings surface. All provinces, except Quebec, signed the Reciprocal Medical Billing Agreement about two decades ago, where a doctor seeing a patient from another province can bill the appropriate provincial medicare plan and be reimbursed as if the patient were from the same province.

But in allowing Quebec to simply opt out, what teeth does the Canada Health Act have? The section on portability states that Quebec must pay the rates of other provinces, or strike a deal with them to pay doctors differently. There is no such deal. The Quebec rate for an in-hospital orthopedic consult, for example, is $61, whereas the Ontario Health Insurance Plan pays about $76 and the British Columbia plan about $99.

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