In October 1966, Tommy Douglas defined portability of health benefits across Canada as one of four major principles. These were enshrined in the Canada Health Act of 1984. Portability supports temporary or permanent labour mobility between provinces. Moreover, Saskatchewan occasionally sends patients to Alberta for joint replacements or breast diagnostic procedures. Those in eastern Saskatchewan are rarely sent to Winnipeg for complex oncology or pediatric care or for severe burns.
Alberta Premier Danielle Smith has called for an Oct. 19 vote on whether to have a referendum on Alberta independence. In both Quebec and Alberta, about 25-30 per cent of the population might consider separating from Canada. Among the many adverse economic consequences, usually overlooked is the predictable loss of portable health benefits in the rest of Canada.
If a province became independent, its citizens would no longer be under the jurisdiction of the Canada Health Act. They would be “non-residents of Canada” when seeking hospital or medical/surgical care in another part of Canada.
The Quebec government has ignored Section 11 of the Canada Health Act, and is the only province that has refused to sign the reciprocal medical billing agreement which covers out-of-province medical/surgical care for most Canadians.
Last year, Quebecers paid out-of-province MDs $12.6 million but were reimbursed only $2.3 million. For example, physicians in Ontario legally charge “non-residents of Canada” and Quebecers according to the Ontario Medical Association schedule with fees nearly three times the rates in the OHIP schedule of benefits. Physicians in Alberta bill at two to five times the schedule of benefits. MDs in other provinces do much the same.
Should Quebec or Alberta become independent, its residents would be billed directly by hospitals in other provinces. With most hospitals running deficits, they charge foreigners what the market will bear. They also require payment prior to discharge or before elective surgery. Consider the following rates for “Non-residents of Canada”:
St. Paul’s Hospital in Vancouver charges $1,355 for an emergency department visit, $4,690 daily for a standard room, and $13,110 for an ICU bed. Vancouver General has a rate of $18,105 daily for the ICU.
An urgent care visit at Victoria Hospital in Winnipeg is $1,452; a standard four-bed room costs $3,066 per day.
The Ottawa Hospital charges $1,249 for an emergency visit. A standard room is $4,323; an ICU bed $9,594 daily. The Queensway-Carleton Hospital in Ottawa bills $1,242 for an emergency or outpatient clinic visit, plus $4,005 for a standard room and $15,642 for the ICU daily.
