Friday, May 23, 2008

Residency Requirements for Health Care - Cross Country

In two previous posts, I stated that I thought the residency requirement for receiving coverage under the Ontario Health Insurance Plan (OHIP) was wrong. I noted that the eligibility requirements for voting in the province of Ontario are less restrictive than the requirements for obtaining health care coverage.

In another, I brought your attention to the danger that a residency requirement can have on a patient.

I asked the question, how do we change it?

So, I decided to see what the other provinces residency length requirements are.

Residency requirements for provincial health plans are as follows:

For Newfoundland & Labrador and New Brunswick, I could not find a residency length requirement. However, both provinces exclude "tourists, transients, and visitors" from coverage.

For Nunavut, I could not find the eligibility requirements for health care coverage online.

In short, Ontario is the least restrictive (assuming NL, NB, and NT have a fixed residency requirement) at 5 months(-ish), versus requiring 6 months across the rest of the country. In an extremely hypothetical example, if I happen to reside for 5 months in Alberta, then 5 months in Nova Scotia, then 2 in Ontario - I could conceivably be denied public health care coverage in Canada. I could vote in three provincial elections - but I would not be entitled to health care coverage in any of the three.

That said, there are numerous exemptions to these requirements. Some provinces include an exemption if you leave the province for working, education, or as long as you tell your respective Ministry of Health before you leave and then provided you come back and reside for the required length again upon your return.

At the heart of these residency-length issues, each province is attempting to exclude "tourists, transients, and visitors" from being covered under their provincial plan. It's not an entirely undesirable condition. Contrast this with the Canada Health Act's requirement that health plans must be portable and universal.

All provinces exclude those covered under federal health coverage (for example, military personnel).

Tourists and visitors, I think, fall into the same category. They are, in effect, temporarily in another province and their health care coverage should be covered by their home province. They likely pay income taxes in another province, are eligible to vote in another province's elections, or they receive mail in another province. It's a no brainer for these folks.

The sticky part is "transient". These are people that are in a permanent or permanent-like situation where they may not have "proof of residency" for the province where they are seeking treatment. Or, like the case of the gentleman from Leader, Saskatchewan, his nearest major centre offering the required health care was in another province.

The "simplest" solution seems to be to make health care a federal responsibility. You get a Canada health card - good for medical care at any hospital or doctor's office in Canada.

Is that the right course?

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