The Government Spending More Money Fighting Claims than Getting People Care

  • October 22, 2014
  • BakerLaw

An article recently published in the London Free Press outlines the transformation of Ontario’s health care coverage claim and appeal process into a system in which the Ministry of Health denies countless deserving claims and it is nearly impossible for a patient to win an appeal to the Health Services Appeal and Review Board (link to article).  The article notes that this is especially true for patients looking to secure reimbursement from OHIP for necessary out-of-country (OOC) medical services.   According to lawyer Perry Brodkin, OOC funding has plunged from $190 million in 2008-2009 to $49 million in 2012-2013, and the number of appeals before the Health Services Appeal and Review Board from Ontarians seeking funding for OOC medical care they could not find in Ontario has dropped from 52 appeals in 2012 to 33 cases in 2013, and now to only 7 appeals in 2014 thus far.

This trend was also confirmed in Health Canada’s Canada Health Act Annual Report for 2012-2013 (link to report). The hospital OOC data found on page 71 of the report demonstrates that claims have increased but payments have dropped precipitously, and the physician services OOC data on page 72 of the report shows that where the number of physician services has dropped slightly, there has been a dramatic drop in payments. Coverage during temporary absences outside Canada (i.e. emergency treatment) has remained stable over this period. These claims are generally very small because acute hospital payments are capped at $400 per diem and stays are short in length because people are required to air ambulance home as soon as it is possible. Therefore, it is clear that the drop in OOC payments for both hospital and physician services is almost assuredly due to the slashing of funding to Ontarians seeking claims for OOC medical care that they could not find in Ontario.

In Chaoulli v. Quebec (Attorney General), [2005] 1 S.C.R. 791, 2005 SCC 35, (link to decision) although the case was ultimately decided on violations of the Quebec Charter, the majority of the Supreme Court of Canada also found that the applicant’s Charter rights were violated by a law that prohibited the provision of private health insurance because delays in the publicly-funded system threatened the health of patients.  It would appear that, as the province continues to cut back on funding of claims from Ontarians forced to go out-of-country for medical care they could not find in Ontario, another Charter case or legislative reform will be required to restore universality of medicare.

Nevertheless, bakerlaw is a strong advocate for patient rights and continues to litigate and win out-of-country funding on applications, applications for reconsideration, and appeals.  For more information on your rights to funding for out-of-country treatment, please feel free to contact us (link).

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