The Ontario government will be ending a program that provides free-of-charge health-care services to uninsured people at the end of the month, something doctors say is extremely concerning for marginalized communities.
In March 2020, as the COVID-19 pandemic was first ramping up, the ministry of health established temporary funding for doctors to provide health-care providers to treat those without coverage under the Ontario Health Insurance Plan (OHIP).
The program allowed anyone to access “medically necessary physician and hospital services.”
In a memo sent to Ontario hospitals and health providers, and provided to CTV News Toronto, the government said this funding would end on March 31.
“Starting April 1, 2023, hospitals should return to pre-pandemic billing practices for uninsured patients,” the memo reads.
“As they did pre-pandemic, uninsured persons will continue to have access to some publicly funded health care services including primary care at one of Ontario’s 75 Community Health Centres, midwifery care, public health, and emergency care. Regardless of an individual’s health card status, Ontario’s public hospitals cannot refuse to provide services to a patient who is faced with a life-threatening medical emergency.”
In a statement, the Ontario Medical Association (OMA) expressed concern about this decision, saying it will be “detrimental to the livelihood of marginalized Ontarians who often face the greatest barriers in our society.”
“Instead, the government will rely on the goodwill of physicians who often exercise a moral obligation to care for uninsured persons without being compensated,” the OMA, which represents the political, clinical, and economic interests of Ontario physicians, said.
An uninsured person is someone who lacks private or provincial health insurance and most often impacts those without residency status, people waiting for permanent residency, foreign workers between contracts, and international students not covered by their universities or colleges.
Challenges also exist for those who experience homelessness and who may not have access to a health card.
The OMA wants the Ministry of Health to extend the program temporarily until a long-term solution can be developed.
The ministry, for its part, says the funding was put in place as a temporary measure to ensure people had access to medical services when it was difficult to leave the province during travel restrictions.
“With lower rates of COVID-19 and the ending of public health restrictions, the province is winding down its pandemic response measures to focus resources on delivering services Ontarians need the most,” it said in a statement to CTV News Toronto.
Doctors have expressed their apprehension over the changes being made so suddenly, especially considering no further action has been taken to reduce other barriers to health care.
Dr. Michael Warner, an ICU doctor at Toronto’s Michael Garron Hospital, told CTV News Toronto that suddenly ending a program that solved a real equity issue is “cruel.”
“We’re not talking about people who can no longer go to Buffalo to get an MRI. We’re talking about people who don’t have a home,” he said “It was a very good policy that rectified a major inequity that existed before March 25, 2020.”
In order to get a health card in Ontario, an individual needs to physically show up at a Service Ontario centre, provide three forms of identification, and have a home address. The forms, Warner added, are also only in English and French.
“What it means is that if you don’t have a health card, you’re much less likely to get preventive and primary care because you’re not going have an ongoing relationship with a primary care practitioner,” he said.
“When you do get sick, it’s going to be a bigger emergency that’s going to cost the system more. And those on the margins are the ones who are going to be harmed the most in addition to the physicians who treat those marginalized groups, they’re just going to be working for free, and that’s not fair either.”
While uninsured individuals are able to seek care at community clinics and hospitals without a health card, long-time street nurse Cathy Crowe says she can’t think of any benefit to ending the program.
“There’s literally no logic in the decision apart from it means that money that was going to this will go elsewhere,” she said, adding that this will put more pressures on community health centres and hospitals that will be tasked with providing care. “It’s mean-spirited. If the premier and his people think that it’s easy to get into a community health center, it’s not. There’s waiting list to become patients there as well. And emergency rooms, my god the doctors in Toronto ERs anyway, are swamped.”
“The last thing they need is people coming in for an ear infection … they don’t need people coming in for ‘I’m out of my medication, can you help me.’”
Crowe added that any barriers to access would especially prevent unhoused individuals from seeking care, regardless of the location.
When the funding became available in 2020, it was a game changer,” Dr. Andrew Boozary with the University Health Network, told CTV News Toronto.
There are about half a million people in Ontario who do not have insurance, Boozary noted.
“Removing that stigma and barrier for people to access care was a crucial part in what we were trying to do to improve health in marginalized communities,” he said.
“I think the lack of engagement or consultation to have or pull back a program like this will have a real ripple effect through people who will have now much more uncertainty about where or when they can bank on goodwill, which seems to be indicating the memo, as opposed to the kind of policies we need to ensure that people can stay and be healthy.”
Boozary said the pandemic also shed light on how people’s socioeconomic conditions impacted not just their health but the care they received.
“To not learn and build policy on these learnings that came at a very high cost of human life and more disease … That’s the really challenging part to reconcile right now,” he said.
“If the policy messaging is correct, this does real damage to our notions of universality.”
The news also comes as a deal with Ontario optometrists alters coverage for eye exams under OHIP, reducing the number of exams that are covered for seniors to once every 18 months. Seniors will also no longer receive unlimited minor follow-up assessments and people with cataracts will only be covered if they have “clinically significant decreased vision” or if a surgical referral is made.