Media reports about Canadian snowbirds being stranded in US hospitals for lack of acute care beds in their home province are not new. This is a chronic problem that shows no evidence of improvement any time soon as Canada continues to languish far behind most other industrialized nations in building up its inventory of acute care hospital beds.*
Shortly after CBC broke the story, a hospital bed was located in Cambridge, Ontario, and Mr. Skingley was successfully transferred.Recently, the CBC reported that Robert Skingley, a resident of Kincardine, Ontario, had been hospitalized in South Carolina for almost three weeks undergoing treatment for viral infections as his family worked to find a Canadian physician prepared to accept him for treatment and a hospital that had a bed available—pre-requisites for any air ambulance transfer.
According to the CBC, Mr. Skingley had purchased private supplemental travel insurance to cover emergency medical and hospital expenses he might encounter on his trip. Had he not, he would have been responsible for the full bill, except for a tiny portion payable by his provincial government health insurer—in this case, OHIP. Normally, provincial government payments to foreign hospitals account for less than 10 per cent of billed charges, and it’s up to private insurers, or to travellers if they have no private insurance, to make up the difference. Given that those expenses could easily climb to several thousand dollars per day in a US hospital, it is in the insurer’s interest to get their client home as quickly as possible.
Canada’s official one-stop travel site warns:
If you plan to go abroad, even on a day trip to the United States, you should purchase the best travel insurance you can afford before you leave Canada.
Your Canadian insurance is almost certainly not valid outside Canada. Your provincial or territorial health plan may cover nothing or only a very small portion of the costs if you get sick or are injured while abroad.
So Who Pays?
All patients who are admitted to a US hospital (for-profit or not-for-profit) are required to sign agreements that they are ultimately responsible for their own charges—be they domestic or foreign. And so if the patient’s insurer denies a claim because of some non-disclosure or pre-existing condition exclusion, the patient is expected to pay. That’s why it’s essential that travellers know their contracts and clearly understand what their own liabilities are. There are no government bailouts for travellers who can’t pay their hospital bills in foreign countries. Neither is there much protection behind their own national borders.
US hospitals are not averse to unleashing professional collectors to get what they can from patients who don’t pay. Hospitals are largely self-sufficient and they can’t necessarily count on government bailouts if they finish the year in the red. They must be run as businesses. And occasionally that requires using international collection firms (e.g., in the UK, Switzerland, even Israel) to track down and pressure non-payers to become payers. And they’re pretty good at what they do.
Though Canadian travel insurance is designed to cover emergencies only, the policies are generous: most say they will cover up to at least one million Canadian dollars per policy term, and some go up to five million or more. Of course, insurers will more than likely get you back home long before you get to those limits, but the benefits they provide, such as return to Canada of a client’s vehicle, coverage of expenses to bring family members to a patient’s bedside, and commercial or air ambulance repatriation to a hospital in, or close to, their home communities, are pretty well standard-issue in all policies and they’re pretty well thought out actuarially.
But if a community hospital in Northern Alberta, or a tertiary care health centre in central Ontario put up a No Vacancy sign, and a patient who should have been repatriated isn’t, all of that actuarial refinement goes out the window. When a Toronto area resident who suffered a heart attack in St. Louis, Missouri,
in 2011 was forced to lie in a hospital bed in that city for 10 weeks because neither the health ministry nor hospital admissions personnel in the entire metro area could find a spare bed for him, who could put a price tag on that family’s disruption?
So we ask again: Who pays?
*Out of the 30 industrialized, mostly Western nations that make up the Organization for Economic Cooperation and Development (OECD), Canada ranked second from last in number of acute care hospital beds (1.7) per 1,000 population in 2011. Only Mexico (1.5 per 1,000) ranked lower. The US ranked 2.3 beds per 1,000 population; Australia, 3.4; Germany, 5.4; the UK, 2.3. The numbers refer to the most recent year (2011 or 2012) for which data are available. This is not to say that more hospital beds necessarily equate to better care. But they do indicate that if Canadian patients who can be repatriated aren’t, even though they are willing to pay for it through their premiums, they’re certainly being deprived of the universality and portability the Canada Health Act of 1984 was designed to ensure.
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