When Malady Strikes Outside Canada

What Every Doctor Should Know About the Limits of Canada's Provincial Health Insurance Coverage in Foreign Jurisdictions

Tracey Tremayne-Lloyd
Lonny J. Rosen
Tremayne-Lloyd Partners,
Toronto, Ontario

Increasingly, primary care physicians are facing the stress of dealing with the wrath of patients who have incurred staggering and ruinous bills for medical attention while travelling outside of Canada. Notwithstanding the widespread publicity attracted by the amendments to the Health Insurance Act regarding out-of-province claims, enacted in 1992, patients continue to labour under the false impression that if they require emergency medical care outside of Canada, the provincial health insurance plan will pay for that care.

Considering the large number of rapidly aging individuals and their fixed income, an understanding of the provisions and limitations of the provincial health insurance reimbursements for the out-of-country medical services is a vital part of the practice of primary care physicians--particularly physicians who treat a significant number of geriatric patients. Physicians should offer counseling on the risks facing patients with pre-existing medical conditions who are preparing to travel out of the country. This may be considered a basic legal duty for every physician if they wish to avoid the possibility of being sued for negligence in case the patient falls ill and suffers financial ruin as a result of foreign medical bills.