Several times a week, a man who faces problems of homeless people and mental health arrives at the Emergency Department occupied in the center of Toronto, where Dr. Bernard Ho works, and doctors treat him even though they are not paid for doing so.
This is because man does not have a valid health card, and it is not the only one.
HO said many doctors are forced to support the cost of caring for needy people who cannot demonstrate that they have health insurance.
“We see them all the time. And unfortunately, they don’t pay us for them,” Ho told CBC Toronto.
Currently, most doctors throughout the province cannot bill Ontario Health Insurance Plan (OHIP) for patients who cannot prove that they have coverage.
The Medical Association of Ontario hopes to change that and is working to end a new compensation agreement with the provincial government that includes the reintroduction of what calls a “good faith” payment policy, discarded for the first time in 1998.
What is a ‘good faith’ payment policy?
During the Covid-19 Pandemia, Ontario revived a version of the “good faith” of the twentieth century, creating a current of funds to ensure that doctors receive payments every time they treated someone, even when the patient was not secured. The policy was discarded again in 2023.
The Ministry of Health told CBC Toronto in a statement that you cannot comment on specific proposals while in active negotiation with the OMA.
If the proposal is approved, the “good faith” payment system would be activated in three scenarios, according to the OMA:
-
Newborn patients experience failures or delays while waiting for a permanent health card.
-
People who are eligible for OHIP but do not have valid documentation or valid coverage, a category that could include people who experience homeless people, mental health problems or other barriers for documentation.
-
Uncreated patients who are presented in critical conditions, who cannot or do not have someone available to provide documentation. The category could include undocumented residents, temporary residents who experience coverage lapses, travelers without sure they face medical emergencies and people who face complications or emergencies after elective health or birth tourism.
‘Free for all’ is not the goal, says the president of OMA
It is that third scenario, in which doctors would announce care for patients without insurance, which could face rejection, the OMA said in a 2024 report.
“The ministry can indicate that this is simply not your problem to manage … Some members of the public may feel similarly,” says the report.
According to the proposed policy, hospitals would need to make reasonable attempts to verify someone’s coverage, said OMA president, Dr. Zainab Abdurrahman.
But if that is not possible, she believes that doctors who care for them should still receive payment.
“Our true approach is really ohipeligible. Can anyone [ineligible] Slide there? There is always a possibility, “said Abdurrahman.
“We are being very specific and very intentional … to help relieve fears that this will only be medical care for everyone so that everyone will come and obtain medical attention paid by ontarium taxpayers,” he said. “That is not our goal.”
When the policy was in force during the pandemic, the OMA discovered that 7,000 Ontario doctors provided 400,000 cases of care for patients without insurance.
There are similar programs throughout Canada: OMA
It is not clear if bringing politics back could encourage more medical tourism, said Boriana Miloucheva, assistant professor of Health Economics at the Public Health School of Dalla Lana.
“The option to obtain medical services and not pay [the bill] There is already, “he said.” It is a good faith program, but there should be reviews about who is really invoicing and what they are really billing, “he said.
Other provinces, such as BC, Alberta, Saskatchewan and Quebec, provide similar payment options for emergencies, according to the OMA. Some of them allow retroactive billing or accept shelter mail addresses for homeless people as a residence test for those without health card.
A similar policy was also recently implemented in Manitoba.
The Medical Association of Ontario hopes to reach a new agreement with the province that would change the way in which family doctors are compensated. Give CBC Manucdoc has more about what the proposed agreement includes.
Ultimately, says Dr. Ho, this is more than being compensated by work. He says it is a health capital problem for the most vulnerable populations in the province, which could delay care or reject the recipes they cannot pay because they cannot demonstrate that they are eligible for OHIP.
HO says that politics could end up saving money to the province, since people who postpone care could face more serious health problems that need to deal with later.
“We need to reduce these barriers to care and … create fair processes for these patients because they look disproportionately affected by this,” he said.
Abdurrahman said he expects an update on the proposed policy this fall.
