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International Patients: What Care Can’t Be Bought at the Hospital

The Question: I would like to know if your hospital accepts international patients and if so, what is the process? My brother needs a full check up.

The Answer: You would think hospitals would see patients like your brother as a way to generate monies to help pay for all the other patients who come through their doors but that is not the case.

Like many hospitals across Canada, Sunnybrook does not currently accept international patients requiring non-urgent care – largely due to capacity issues – but that could change in the future. The hospital is full and so treating a paying patient could potentially mean displacing one covered under the Ontario Health Insurance Plan, which funds public health services for the province.

This is not the practice of every hospital. Some do charge a higher international rate to outside patients for procedures, so that they can use that revenue to open more beds. But that approach is taken after careful deliberation, after developing a policy for international patients, and usually for very specialized, lucrative procedures – not for routine check ups, which by the way are not even funded in British Columbia – unless, of course, that the doctor has a reason for doing the examination.  [Nova Scotia, Newfoundland and New Brunswick also do not cover them in symptomless patients.]

No matter what decision a hospital makes on revenue generation, there is one thing that can never take place: allowing a paying patient to oust a Canadian patient who also paid for their health care through their taxes. When that happens, it violates the Canada Health Act, not to mention eroding citizens’ confidence in the health care system. It would be a devastating consequence.

Even the sheer act of trying to bring patients to a hospital carries with it significant issues surrounding liability.

“If we do anything to bring them here, you have to get private malpractice insurance,” according to Sally Bean, ethicist and policy advisor at Sunnybrook Health Sciences Centre. “It gets quite complex pretty quickly. “

If your brother came to the hospital with an urgent or medical emergency with or without insurance, however, he would be treated because “there is a legal and ethical obligation to provide care,” Ms. Bean said in an interview.

Dialysis is one example. If a patient requires it and can only obtain it in your country of origin by paying for it that makes it inaccessible for many patients.

“It’s tough because you would be sentencing people to death,” said Ms. Bean, noting that in some cases, uninsured dialysis patients have had treatment provided to them.

Other types of patients include those without legal status who came here on a visitor’s visa years ago but stayed, those waiting for their 90 days to pass before their provincial insurance kicks in, or tourists who have had a motor vehicle insurance accident but did not buy travel insurance. In the latter case, they would most certainly be treated here but there would also be efforts to recover the cost afterwards.

“You have to find that reasonable balance, think about what is the fair response, then we have to be resource stewards with our public health care dollars,” said Ms. Bean. “We have to ask: Is it justifiable? Are we disadvantaging Ontarians?”

As stewards of public funds, public institutions must be very careful on how it spends monies and to make sure it is doing so responsibly.

In answer to your question, we do not allow patients to come here for check ups. And I expect many other Canadian hospitals do not as well. It may be that institutions do look for revenue-generating opportunities in the future, but those will likely involve super specialized procedures that they are particularly well known for performing.

About the author

Lisa Priest

Lisa Priest

Lisa Priest is the Director and Patient Engagement Lead of the North East Toronto Health Link.

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