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Should there be requirements for tourists and foreign travelers to ensure that : doctors differ of opinions


Denis Méthot

22 October 2018 11:30

Photo : Freepik

Should we require the tourists and foreign travelers to take a travel insurance before coming to Canada in the event that they should get health care during their stay in the country ? The question dividing health practitioners.

An ontario physician, who has had to deal with cases of the kind, believes that this obligation could be imposed to any traveller temporary entering Canada. One of his colleagues, quebec is in disagreement with him.

Dr. Charles Shaver, general internist in Ottawa, columnist and president of the section of general internal Medicine of theOntario medical Association (OMA), has already lived this situation, as several physicians who provide emergency in large canadian cities. It tells, in a text recently published on the site Occupation Health, having received a man of 58 years suffering from dyspnea (difficulty breathing). However, it seems we have diagnosed with a valvular heart disease for the first time in 2013. At the time it was discussed, his symptoms were greatly aggravated in five years.

This patient was originally from Grenada and was visiting his family in Ottawa. He planned to stay there for several months even though he had no travel insurance. Dr. Shaver said to have reduced its review to the minimum, but his daughter had to pay for the medical visit and exams.

“This situation is without a doubt common for my colleagues who practice in larger cities. Especially for those who are asked to take care of patients to the emergency room, ” says the ontario physician, with whom the Journal of the insurance is also maintained.

Require health insurance for travelers ?

It reminds us that a travel health insurance is mandatory for canadian tourists who want to visit a number of countries and to apply for a visa for the 26 countries of the Schengen area in Europe. Conversely, the citizens of 150 States need a visa to enter Canada. However, health insurance is mandatory only for obtaining a super visa, not for a simple visitor visa.

According to its figures, the number of overseas visitors increased by 4 % per year in this country. Should Canada start to require health insurance, you ask ?

Dr. Shaver agreed that these insurance policies have limits. They usually do not cover the routine visits for monitoring of hypertension, diabetes, etc, They are usually difficult to obtain for patients suffering a pre-existing condition, especially if their medication has been changed in three to six months, or they exclude these problems already existing. Nevertheless, they ensure a high level of protection for unforeseen events.

Tens of millions of dollars in unpaid debts

Travel health insurance compulsory for visitors to have the effect of reducing the number of “bad debts” contracted by tourists without coverage, ” says Dr. Shaver. In the current state of things, doctors and hospitals are left with unpaid claims by travellers and foreign tourists who have received health care and who have not paid their invoice. The health institutions are making efforts to be paid, but in many cases is just lost and are lost for these health care given to this category of patients are very high.

From 2013 to 2018, indicate the figures obtained by the Journal of insurance, the total of bad debts, health care fees unpaid by tourists and foreign visitors at the CHU de Québec, an institution that includes five hospitals, amounted to nearly 2 million dollars (M$). In 2016, the TVA network had conducted research on the topic. It had been established that quebec hospitals, including the most important hospitals in montreal, sought to recover a total of 55 million dollars (M$) from foreign patients for care and treatment received during their stay in Quebec.

Two possible avenues

How to reduce or eliminate these losses must wipe the canadian health system ? Dr. Shaver offers two avenues. First, he said, the federal government should raise the awareness of foreign visitors to buy health insurance when they come to Canada. It should perhaps even be made mandatory for stays of more than a few days, in spite of its limitations.

Secondly, it suggests that a company like Medavie Blue Cross to extend its coverage to cover some of these visitors at high risk for serious complications and unforeseen requiring hospitalization. But Dr. Shaver is not fishing by the excesses of humanism. According to his proposal, the family would charge a significant premium each week, the insured would have a higher deductible to pay and the insurance would exclude routine examinations. That is, he believes, which could reduce the costs for the host family in addition to encourage them to shorten the total duration of the visit of his own, which would reduce the risk of a complication occurring during their stay on canadian soil.

“It is Ottawa that allows these temporary visitors to enter the country. The government needs to health care professionals the assurance that they will be paid for the treatments unexpected that any visitor could receive during their stay “, says Dr. Shaver.

A simplistic solution, believes the QMA

Dr. Hugo Just

These scenarios do not collect not, however, the support of Dr. Hugo Viens, president of theQuébec medical Association (QMA), a large association, which brings together medical specialists and family physicians in quebec.

“The proposed solution appears simplistic, the judge said it in an e-mail sent to the Journal of the insurance. This seems difficult to apply in practice, and this would lead probably to the demands of reciprocity. One can also question the fact of wanting to impose a travel insurance to people who do not have health insurance in their country. There is an equity issue. Also, would it require for Canadians who travel outside the country to contract an insurance to be covered in the event of a health problem abroad ? All of this would, of course, economic benefits and may ultimately cost in Canada “.

The Dr Just acknowledges that there was indeed a problem of substance, since hospitals and doctors are not paid for emergency treatment that they gave to foreign travelers. He believes that it is their duty of care to these people in certain situations, even if they do not have travel insurance.

“If the doctors are entitled to ask for a payment before you provide non-emergency care, they have an ethical obligation to treat a person in case of emergency,” he recalls. These are the doctors that have decided to regulate themselves by imposing a rule of treatment of persons in danger, without regard to the payment. Therefore, one may ask whether it is the federal government to address the effects of this professional component. Other groups of professionals such as lawyers agree that, as a part of the services they provide are pro bono. Is that medical groups could take example on these colleagues ? “

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