The Answer: This type of question – a pregnant woman living out of country – wondering if she can give birth in Canada is one we receive a few times a year. Without meeting specific criteria, it is unlikely Sunnybrook could accommodate you.

Generally speaking, obstetricians are not supposed to accept patients from out of country unless they are Canadian citizens living abroad, who wish to come home to have their baby delivered. Women who are non-citizens, are fully insured, who may be residing in Canada for their work and have family in this country are also accepted by obstetricians to give birth here, according to Arthur Zaltz, Chief, Department of Obstetrics and Gynaecology.

According to Sally Bean, ethicist and policy advisor at Sunnybrook, an “out of country obstetrical patient who is not physically present in Canada poses numerous liability and insurance coverage issues.”

As a result, it is difficult for physicians to accept them as patients.

Doctors who agree to accept out-of-country patients would be viewed as having directly or indirectly solicited the patient and may not necessarily be provided coverage if they were sued outside of Canada, she said.

The federal government has been watching this issue closely and is considering changes to citizenship rules in a bid to stamp out so-called birth tourism – cases where a foreign national comes to Canada to deliver their baby, knowing the child will get full citizenship.

Currently, under the Citizenship Act, children born in Canada to parents who are temporarily in the country – visitors, students, temporary workers, asylum claimants – are automatically conferred citizenship, allowing them to access the range of taxpayer-funded benefits that come with it.

Canada and the United States are among the few countries worldwide that confer automatic citizenship by birth on soil; most other countries limit citizenship to those with a parent with permanent status, according to Remi Lariviere, spokesman for Citizenship and Immigration Canada.

“We have been considering bringing forward comprehensive amendments to the Citizenship Act,” Jason Kenney, Minister of Citizenship, Immigration and Multiculturalism, said in a CBC television interview in 2012. “…We don’t have a precise timeline. But we are looking at modernizing the Citizenship Act and this might be considered as one of those amendments.”

The post Birth Tourism: The Pregnant Patients Most Doctors Cannot Accept appeared first on Your Health Matters.

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.

The post International Patients: What Care Can’t Be Bought at the Hospital appeared first on Your Health Matters.