Several times a week, a man facing homelessness and mental health issues comes to the busy emergency department in downtown Toronto where Dr. Bernard Ho works, and doctors there treat him despite not being paid to do so.
That’s because the man doesn’t have a valid health card — and he’s not the only one.
Ho said many doctors are forced to bear the cost of caring for people in need who can’t prove they have health insurance.
“We see them all the time. And unfortunately, we’re not paid for them,” Ho told CBC Toronto.
Currently, most doctors across the province can’t invoice the Ontario Health Insurance Plan (OHIP) for patients who can’t prove they have coverage.
The Ontario Medical Association is hoping to change that and is working to finalize a new compensation deal with the provincial government that includes the reintroduction of what it calls a “good-faith” payment policy, first scrapped in 1998.
During the COVID-19 pandemic, Ontario revived a version of 20th-century “good-faith” payment policy, creating a stream of funding to ensure doctors got paid whenever they treated someone, even when the patient was not insured. The policy was scrapped again in 2023.
The Ministry of Health told CBC Toronto in a statement it’s unable to comment on specific proposals while in active bargaining with the OMA.
If the proposal is approved, the “good-faith” payment system would kick in under three scenarios, according to the OMA:
Newborn patients experiencing glitches or delays while they await a permanent health card.
People who are OHIP-eligible but don’t have valid documentation or valid coverage, a category which could include people experiencing homelessness, mental health issues or other barriers to documentation.
Uninsured patients presenting in critical conditions, who are unable or don’t have someone available to provide documentation. The category could include undocumented residents, temporary residents experiencing lapses in coverage, uninsured travelers facing medical emergencies, and individuals facing complications or emergencies after elective health or birth tourism.
It’s that third scenario, in which doctors would bill for care for uninsured patients, that could face pushback, the OMA noted in a 2024 report.
“The Ministry may indicate that this is simply not their problem to manage … Some members of the public may feel similarly,” the report says.
Under the proposed policy, hospitals would need to make reasonable attempts to verify someone’s coverage, said OMA president Dr. Zainab Abdurrahman.
But if that’s not possible, she believes the doctors caring for them should still get paid.
“Our real focus is really the OHIP-eligible. Could someone [ineligible] slip in there? There’s always a possibility,” Abdurrahman said.
“We’re being very specific and very intentional … to help allay the fears that this is just going to be a free-for-all for everyone to come and get Ontario taxpayer-paid health care,” she said. “That’s not our goal.”
When the policy was in place during the pandemic, the OMA found that 7,000 Ontario physicians provided 400,000 instances of care to patients without insurance.
It’s unclear whether bringing back the policy could incentivize more medical tourism, said Boriana Miloucheva, an assistant professor of health economics at the Dalla Lana School of Public Health.
“The option to get medical services and not pay [the bill] already exists,” she said. “It’s a good-faith program, but there should be reviews about who is actually billing and what they’re actually billing,” she said.
Other provinces, such as B.C., Alberta, Saskatchewan, and Quebec, do provide similar payment options for emergencies, according to the OMA. Some of them allow retroactive billing or accept mailing addresses from homeless shelters as proof of residency for those without a health card.
A similar policy was also recently implemented in Manitoba.
Ontario doctors are close to a new compensation deal. Here’s what it includes
Ultimately, says Dr. Ho, this is about more than getting compensated for work. He says it’s a health equity issue for the province’s most vulnerable populations, who might delay care or turn down prescriptions they can’t pay for because they can’t prove they’re eligible for OHIP.
Ho says the policy could end up saving the province money, since people postponing care could face more serious health issues that need treating later on.
“We do need to reduce these barriers to care and … create fair processes for these patients because they are disproportionately affected by this,” he said.
Abdurrahman said she’s hoping for an update on the proposed policy this fall.
