Healthcare in Canada (Ontario)

[daverobev]

I was having a general chat with SIL over halloween. She was telling me about someone whose cancer drugs where something like $6k a month.

I am/was under the impression that in the UK at least, stuff like drugs are mostly paid for (you pay 6 or 8 pounds, AFAIR, for a prescription). SIL was saying that the provincial system generally covers you in emergencies, but once you're out of hospital, you're on your own.

So I was wondering if getting health insurance is worth it here? I had a bit of a look around and found the Trillium Drug Benefit - after 4% of household income you generally get stuff paid for. Doesn't cover all drugs but generally, you're ok? So if household income is $100k, you might in a bad year pay $4k in drugs and then you're off the hook.

Am I missing something? Do people feel private insurance is worth it? We can certainly afford $4k should one of us, God forbid, get cancer, but $6k a month for an undetermined amount of time would be pretty painful!

Just wondering what people think/feel. Neither of us get anything from employers, we're mostly self employed.

Also interested in contrasting info from Quebec, BC, etc.

[Cathy]

...SIL was saying that the provincial system generally covers you in emergencies, but once you're out of hospital, you're on your own....

The suggestion that Ontario's health insurance program covers only "emergencies" is too narrow, but it's true that provincial coverage throughout Canada tends to be less comprehensive than a typical health insurance plan in the United States (but also dramatically less expensive).

As you correctly indicate, each province has the constitutional authority to create its own healthcare system and to determine what public coverage, if any, it wants to offer to its residents. Indeed, "[i]t would be open to [a province] to adopt a U.S.-style health care system. No one suggests that there is anything in our Constitution to prevent it". Chaoulli v. Quebec (Attorney General), [2005] 1 SCR 791, 2005 SCC 35 at ¶ 176 (LeBel and Fish, JJ, dissenting but not on this point). The Canada Health Act, RSC 1985, c C-6 ("CHA") specifies the conditions under which the federal government will subsidise the healthcare system of a province, but that statute does not create any rights enforceable by ordinary people, because the power to enforce the statute is vested solely in the federal Governor in Council. CHA §§ 15-17. Thus, to determine what a province offers by way of public health coverage, one has to turn to the laws of that province.

Ontario's system of public health insurance is authorised by the Health Insurance Act, RSO 1990, c H.6 ("OHIA"). Every resident of Ontario is entitled to enroll in this insurance plan, subject to certain conditions. OHIA § 11(1). The plan covers not only emergency and medically necessary services, but also all other "[p]rescribed health care services rendered by prescribed practitioners under such conditions and limitations as may be prescribed". OHIA § 11.2(1)(3). The Ontario Lieutenant Governor in Council is authorised to make regulations "governing insured services, including specifying those services that are not insured services". OHIA § 45(1)(e). The regulations provide that many elective services are covered. For example, elective laboratory tests are generally covered if authorised by an appropriate professional. General, RRO 1990, Reg 552 ("Reg"), § 22(1). The regulations also incorporate by reference the contents of the "document published by the Ministry of Health and Long-Term Care titled 'Schedule of Benefits — Physician Services under the Health Insurance Act (October 1, 2005)'", including listed amendments thereto. Reg § 37.1. That document is available online and appears to be 747 pages long, specifying a broad variety of covered services.

[scottish]

Ontario also has the Trillium drug plan which can provide assistance in cases where the drug costs are significant.   And I think there's a drug plan for seniors.   You need to look at them closely though.

[backyardfeast]

All the provinces provide universal basic and emergency health care, though there are variations both in coverage and in how the costs are paid.  Here in BC, we pay a monthly premium (ours is $130.50 for 2 people; drives me a bit nuts--I'd rather pay through my taxes!).  In BC we do have a pharmacare program for catastrophic drug costs, and drugs for seniors are generally free.

Most of us, though, also have extended health care benefits through our employers, and this makes a BIG difference.  Policies cover improved hospital benefits, drug coverage, some travel insurance, extra therapies like massage or physio, mental health support, as well as dental and vision coverage not included in our regular Medical Services Plan.

Many folks I know who are self-employed or for whatever reason don't have extended benefits do buy private insurance.  It's often not that expensive for a whole suite of services.  I'd definitely look into what's available and decide for yourself.

Slightly off-topic, and not knowing your backstory, the other PITA is often that provinces have residency requirements before their medical plan coverage kicks in.  When you move province to province these can vary, and you can get stuck.  BC has a 6-mo residency requirement, for instance.