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Dodging the health insurance minefield

By David South

Today’s Seniors (Canada), 1992

Don’t leave home without it. No, not American Express Travellers cheques but health insurance. With changes to OHIP coverage for out-of-country hospital visits and rising U.S. health care costs, any snowbird who pays a visit to an American hospital will face hefty bills. To make things even more complicated, the recent growth in competing travel health insurance schemes in Canada has created a minefield of policies that must be entered with caution.

Luckily for snowbirds, the newly formed Canadian Snowbird Association is trying to make these changes a little easier to cope with. Formed in March, the Association boasts 8,500 members and is looking for more. They hope to advocate for the rights of snowbirds and collect information on private insurance plans to help seniors make the right decisions.

Communications co-ordinator Don Slinger says he will have a list of appropriate private health insurance policies ready by the end of August. The Association has been meeting with private insurance companies to find out the best plans.

“Snowbirds shouldn’t be in a hurry to get insurance,” says Slinger. “Many insurance companies are using the situation to exploit panic-stricken seniors.”

Slinger warns snowbirds never to go down to the U.S. without extra insurance on top of OHIP. “OHIP is just a drop in the bucket of the cost of a stay in an American hospital. Unfortunately, a lot of people still take the chance.

“I had been going south for 12 years without a problem until a ruptured appendix. It ended up costing me $12,000 for an eight-day hospital stay.

“When we met with the government they weren’t sympathetic. They said snowbirds are a wealthy group and can afford the payments. However, a lot of people are on fixed incomes and won’t be able to afford to go south with these higher costs.”

Slinger advises against buying coverage after arriving in the U.S. The Snowbirds Association emphasizes that it believes in medicare and will fight hard to ensure it provides full coverage for seniors.

Gerry Byrne, a vice-president at non-profit insurers Blue Cross warns against buying U.S. insurance because companies require a medical exam and skim off the healthiest people for full coverage. But Blue Cross itself will introduce rates based on age and medical conditions in September.

American health insurance plans have long been criticized for hurting older seniors and those with ongoing medical conditions. In these schemes, the healthiest seniors pay low premiums while seniors with chronic conditions are saddled with higher rates or, worse still, refused coverage. Unlike medicare – which covers everybody regardless of their health – private insurers are tempted to reduce their costs by covering only the lowest risk group – favouring the young and healthy.

Unfortunately, a quick survey of travel health insurance plans shows this trend to be in full bloom in Canada. Credit card companies, which have recently begun to offer travel health insurance, are revising their conditions. The Royal Bank’s Visa Gold card will drop coverage for seniors over 65 starting Nov. 1. The Canadian Imperial Bank of Commerce and Scotia Bank Visa cards still offer coverage to seniors – but both are revising this. American Express’s annual plan has no age limit, while its per trip plan has a higher rate for seniors between 60 and 74 and doesn’t cover anybody 75 and over.

Suzanne Deul, who helps market the Toronto Dominion Bank Visa card, blames the insurance companies for changes. “Because of high costs, the pressure is on to change policies. We are trying to be more equitable but the insurers want age restrictions. In some ways it could be justified to charge more for people who attract higher costs.”

With so many health insurance companies losing money covering seniors, the challenge for private insurers is to make covering seniors profitable without excluding people. To this end, Robin Ingle, president of John Ingle Travel Insurance, has instituted changes to increase the money available for more expensive hospital stays.

“About one-third of our policy holders are over 65, and we have a lot of snowbirds. This group is only getting bigger, so instead of raising rates and placing restrictions, we increased the number of policy holders to include a broad range of people young and old.”

Ingle blames rising U.S. health care costs for making it unprofitable to provide health insurance to seniors. His company has set up an office in Florida to prevent hospitals overcharging Canadians and has negotiated deals with some hospitals for lower rates. John Ingle Travel Insurance offers special rates for seniors’ groups and gives a 10 per cent discount to members of the Canadian Association of Retired Persons.

Three years ago there were 10 companies in Canada offering travel insurance; now there are over 50.

According to Ingle, many of the neophyte companies are losing money. “I predict the whole industry will shrink because they have had high losses and can’t take care of their clients. I would advise seniors to watch out for companies that might not be around a year from now.”

Ingle says seniors should also beware of glitzy marketing and flashy pamphlets and read the fine print to make sure the policy covers their age and medical condition.

Irene Klatt of the Canadian Life and Health Insurance Association, which represents all private for-profit insurers, advises seniors to look for insurance plans that have toll-free numbers that can be called 24 hours a day in an emergency. This will cut down on hassles with American hospitals which will not admit patients without insurance. The Association also has its own toll-free advice line staffed by seniors from the insurance industry. Klatt warns that her association represents all for-profit insurers and can’t favor one scheme over another but does have a pamphlet that offers advice on choosing insurance.

Insurance, of course, isn’t enough to ensure a healthy stay. Irene Turple of the Canadian Association on Gerontology has some helpful health tips: “Discuss your trip with the family doctor. Make a list of all your medications; and remember – the names of the drugs can be different in the States. If you have an echocardiogram handy, bring it along. Make a health diary listing your medical history. Remember that physicians aren’t all-knowing and if you can provide as much medical information as possible it can make a difference.”

Turple also stresses getting immunized for the flu before going to the States and remembering to cover up from the sun.

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© David South Consulting 2022

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Health Care In Danger

Worrying breakdown in Ontario reforms

By David South

This Magazine (Canada), October-November, 1992

The Senior Citizens’ Consumer Alliance for Long-Term Care’s report on the Ontario New Democratic government’s health care reforms, released in July, documents what many people suspected: the much-needed reforms are mismanaged and dangerously close to chaos.

The report compares the present crisis to the failed attempt in the seventies to move psychiatric care out of institutions and into communities by closing 1,000 beds. Patients were left with inadequate community services, resulting in many homeless and jailed former patients. The alliance fears seniors – the biggest users of health services – could fall victim to reforms in the same way.

According to many health care reformers, Bob Rae’s government seems to have lost control of the issue, resulting in massive job losses and a worrying breakdown in services.

The NDP’s health care document “Goals and Strategic Priorities” reads like a wish list for progressive health care reformers, ranging from disease prevention programmes to improved access to health care for minorities, natives and women. To many, the debate isn’t over these goals but how they are achieved and what the government’s true motives are. Under pressure from big business and its lobby groups, the NDP is desperate to save money where it can, and as Ontario Health Minister Francis Lankin says, “not disrupt or destroy business confidence.”

Emily Phillips, president of the Registered Nurses’ Association of Ontario, is blunt: “The NDP’s plans sound good on paper, but they can’t give a budget or direct plan on how they hope to carry out reforms. They are going about things backward. They cut hospital beds and lay off staff without having community health care services ready.”

The national trend in health care is to deinstitutionalize and bring services to homes and communities. It is hoped that emphasizing prevention and healthy living will significantly reduce the need for hospitals, expensive drugs, surgery and high-tech equipment. The NDP has pledged to spend $647 million to reform long-term care services by 1997 – creating services that will allow seniors to stay in their own homes.

Problem is, the NDP has embarked on radical down-sizing of hospitals – closing beds and laying off thousands of health care workers – right now. Lankin claims that in the worst-case scenario, layoffs this year wouldn’t exceed 2,000, but the Ontario Hospital Association claims 14,000 jobs are in jeopardy. Phillips believes it will be hard to estimate job loss: “It is hard to even record the number of nursing jobs lost, because for every full-time job cut many part-time and relief positions go with it.”

Chaos will result when people who depend on hospitals have nowhere to turn but the inadequate community health care services, which are uneven and narrowly focussed. To make things worse, the same funding restrictions placed on hospitals have also hit the services that are supposed to save the day.

“I haven’t heard of any change in the quality of care. It is just too early,” says Phillips about the effect of layoffs on hospitals. “Right now the nurses are picking up the slack, but soon they will burn out. I don’t feel confident this government has the management skills to do this. I’d like to see a plan in place before moving people into the community.”

Training for laid-off hospital workers will have to come from the $160-million allocated for retraining workers laid off by cities, universities and school boards – all of whom are coping with record-low budget increases.

In February, Lankin appealed to hospitals to do everything in their power to make layoffs painless and to trim doctors and administrators first. But the NDP has yet to pass legislation that would bind hospital boards to make the right cuts. The boards operate at arm’s length from government and continue to make unnecessary decisions, ignoring the NDP’s moral pleas.

Rosanna Pellizzari, a member of the Medical Reform Group and chair of the Ontario Association of Health Centres, wants better community accountability for hospitals before they lay off staff and cut services: “Sometimes it makes sense to bring people to hospitals. Planning must be at the community level and open and democratic. Health care workers, who are mostly women, should not be scapegoated for financial problems. Doctors and management should go first. Physicians experience very little unemployment.”

Carol Kushner, co-author of the book Second Opinion, which evaluates the country’s medical system, sees chaos resulting from the conflicting agendas of governments and health care reformers: “Will the tremendous contradictions of institutions be transferred to the community? The federal government is rapidly draining money from medicare while provincial governments are having a hard time. This hasn’t produced extra funds for re-allocating services to the community – which was recommended by reformers. You have to ask: who is going to fall through the cracks?”

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Worldcat.org: Health care in danger: worrying breakdown in Ontario reforms, This Magazine, 26, Oct-Nov 1992, 6

ISSN: 1491-2678

OCLC Number / Unique Identifier: 8250614985

Creative Commons License

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

ORCID iD: https://orcid.org/0000-0001-5311-1052.

© David South Consulting 2022

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Private Firms Thrive As NDP ‘Reinvents’ Medicare

By David South

Today’s Seniors (Canada), August 1993

Many of today’s seniors fought for Canada’s internationally-admired public health system. But more and more people are becoming worried that the combination of health care reform, funding cutbacks and free trade is fuelling the growth of a second tier of private medical services serving the well off. 

The provincial government sees things differently, arguing Ontarians no longer expect government to pay for everything and rather than eroding medicare, the NDP is reinventing it. 

Whichever way one looks at it, private insurance companies, homecare providers, labs and other services designed to make money are becoming more and more involved in the health care business. 

Operating in the territory outside the guidelines of the 1984 Canada Health Act – which sets out the principles of medicare for the federal government to enforce – the private sector has room to expand, at the same time as OHIP coverage is scaled back from more and more services. 

Janet Maher, whose Ontario Health Coaltion (OHC) represents doctors, nurses and other health care workers, worries for the future of medicare. 

“A number of things like accommodation services – laundry, food services – are in the grey area of the Canada Health Act,” says Maher. “So with all these fees that are being introduced, by the strict letter of the law, there is no way to stop them. But as far as we are concerned the spirit of the Act isn’t being observed.”

In its current reforms, the government of Ontario is emphasizing paramedical professions like midwives who fall outside the CHA and aren’t covered by OHIP. The turn to community-based services means that people have to rely more on services and providers that aren’t covered under the CHA. 

Maher says privatizing accommodation services is a recent phenomenon, the result of hospitals finding creative ways to trim their budgets. 

“It’s a new area that hospitals are taking bids on,” she says. “The other thing around the accommodation services is that because they are not categorized, strictly speaking, as health care services, none of this is exempted in the Free Trade Agreement from U.S. competition.”

A recent report by two British Columbia researchers tries to put together this complex puzzle. Jackie Henwood and Colleen Fuller of the 7,500-member Health Sciences Association of British Columbia recently charged that a combination of free trade and budget-slashing governments is eroding the universality of medicare and ushering in a two-tier system. 

Fuller and Henwood identify the Free Trade Agreement as the culprit. While the health care industry created more jobs than any other sector of the Canadian economy between 1984 and 1991, they point out the job growth has been concentrated in the private sector since free trade was implemented in 1989. And they expect worse under the proposed North American Free Trade Agreement (NAFTA). 

“NAFTA will accelerate trends towards a privatized, non-union and corporate-dominated system of health care in Canada.”

One provision of the Free Trade Agreement has also made it possible for U.S. companies to compete against Canadian firms in health care. Chapter 14, “health-care facilities management services”, allows wide-open competition. 

Under NAFTA, provisions will bind all levels of government to consider for-profit health care companies on both sides of the border on equal footing with public providers when bidding for services, and entitles them to compensation if they can prove to an arbitration board they’ve been wronged. 

“That represents a substantial encroachment on the democratic right of local, provincial and federal governments to make decisions,” says Cathleen Connors, who chairs the national wing of OHC, the Canadian Health Coalition. 

It’s this plus health care cutbacks – federal and provincial – that’s resulting in service and job cuts and bed closures in the public sector and an increase in privatization, say Henwood and Fuller. These opportunities have not gone unnoticed by private companies south of the border. 

One such company is American Medical Security Inc. (AMS) of Green Bay Wisconsin. After hiring Canadian pollsters Angus Reid to do a survey, AMS saw a profitable market in offering American hospital insurance to frustrated Canadians awaiting surgery. Sixteen per cent of those polled said they wanted this service; that was enough for AMS. 

“One thing that comes across loud and clear is that Canadians for the most part are happy,” says spokesperson Carrie Galbraith. “They know they are taken care of during an emergency. But they are willing to pay a little extra if they need care.”

So far, AMS offers its plan to Ontario, B.C. and Manitoba, with Toronto its best market. Galbraith says plans are in the works to expand to all of Canada except the territories. 

Unfortunately, like most private health plans, AMS cuts its losses by avoiding what Galbraith calls “adverse selection” – anybody with a known serious health problem need not apply. 

Here in Ontario, private for-profit home care services take in close to half of all OHIP billings. Many clients pay out of their own pockets for additional services. 

The Ontario health ministry doesn’t keep statistics on the extent of the private home health care sector, says spokesperson Layne Verbeek. But the Ontario Home Health Care Providers’ Association, a trade group, estimates private homecare companies now employ 20,000 and serve more than 100,000. 

“It’s a market situation,” says Henwood. “If the services aren’t available to people within the public sector, they will go outside of it. We’ve seen this in other countries like England, where they had a public system and now have a parallel private system. If you erode a system enough that people get angry, they are going to start to look for alternatives, and the people with the greatest liberty are those with money.”

But in a recent interview, health minister Ruth Grier was adamant this scenario wouldn’t be allowed to take place in Ontario. She strongly disagreed that medicare is being weakened due to recent changes, and said the government has actually “reaffirmed its commitment to medicare.”  

More from Canada’s Today’s Seniors

Feds Call For AIDS, Blood System Inquiry: Some Seniors Infected

Government Urged To Limit Free Drugs For Seniors

Health Care On The Cutting Block: Ministry Hopes For Efficiency With Search And Destroy Tactics

New Seniors’ Group Boosts ‘Grey Power’: Grey Panthers Chapter Opens With A Canadian Touch

Seniors Falling Through The Health Care Cost Cracks

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CASE STUDY 5: GOSH/ICH Child Health Portal | 2001 – 2003

CASE STUDY 4: UN + UNDP Mongolia | 1997 – 1999

Hannah Institute For The History Of Medicine | 1992 – 1994

Taking Medicine To The People: Four Innovators In Community Health

Take Two Big Doses Of Humanity And Call Me In The Morning

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Critics Blast Government Long-Term Care Reforms

“They cut hospital beds and lay off staff without having community health care services ready…”

“When the elderly… decide that facility-based care is the best option, they can’t get it…”

By David South

Today’s Seniors (Canada), October 1992

Seniors should keep a close eye on the Ontario government’s proposed long-term care reforms. According to critics, the plan has more than a few bugs. 

The term long-term care encompasses an often confusing web of services, from home-provided community services like meals on wheels to institutional care including homes for the aged, seniors’ apartments and chronic care hospitals. 

Like other provincial governments, the Rae government is trying to rein in escalating health care costs – and long-term care services aren’t immune. They hope that emphasizing prevention and healthy lifestyles, plus providing more services in the home and community, will reduce reliance and expensive health care services like high-cost drugs, surgery and high-tech equipment. According to health minister Frances Lankin, this will preserve medicare in the age of fiscal restraint. 

The government has outlined seven goals for its long-term care reforms: prepare for the coming surge in the over-65 population; cater services to better reflect the cultural, racial and linguistic make-up of Ontario; eliminate confusion over what services are available; involve the community in planning so that services reflect community needs; lessen reliance on institutions; provide support to family caregivers; tighten regulations governing government-run and private facilities; and improve working conditions for the largely female caregiving workforce. 

But many people are wary of the proposed reforms and worry that if they aren’t managed properly, some seniors will fall through the cracks. 

A report released in July by the Senior Citizens’ Consumer Alliance for Long-Term Care Reform blasts the government for being simplistic in its plans. The report compares the present reforms to the failed attempt in the 1970s to move psychiatric care out of the institutions and into communities by closing 1,000 beds. The tragic result in that case was homelessness for many psychiatric patients who found community services unable to help, or, more often than not, non-existent. The Alliance fears seniors – the biggest users of health services – could fall victim to reforms in a similar way. 

Emily Phillips, president of the Registered Nurses’ Association of Ontario, is blunt: “The NDP’s plans sound good on paper, but they can’t give a budget or direct plan on how they hope to carry out reforms. They are going about things backwards. They cut hospital beds and lay off staff without having community health care services ready.”

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) – which operates charitable and municipal homes for the aged, non-profit seniors’ apartments. chronic care hospitals and community services serving over 100,000 seniors – says 4,300 seniors are on waiting lists for their member facilities right now, and things won’t improve if the government continues to reduce the number of long-term care beds. 

But Lankin insists that beds are available in homes and hospitals and it is funding formulas that prevent them from being filled. 

To help carry out its reforms, the NDP will reallocate $647 million by 1996-97. In bureaucratese, this funding is said to be “back-end loaded”, or mostly spent close to 1996-97. 

The problem with this, according to the Alliance, is that the government has already embarked on a radical “downsizing” of hospitals, closing beds and laying off health care workers. Lankin claims the worst case scenario for layoffs this year won’t exceed 2,000, but the Ontario Hospital Association claims 14,000 jobs are in jeopardy. Because of this, the Alliance wants money to be spent earlier to avoid gaps in services. 

Phillips believes it will be hard to pin down the extent of job losses. “For every full-time job cut many part-time and relief positions go with it,” she says. 

Dr. Rosanna Pellizzari, a member of the Medical Reform Group and chair of the Ontario Association of Health Centres, wants better community accountability for hospitals before they lay off staff and cut services. “Sometimes it makes sense to bring people to hospitals,” she says. “Planning must be at the community level, open and democractic. Health care workers, who are mostly women, should not be scapegoated for financial problems. Doctors and management should go first. Physicians experience very little unemployment.” 

Many nursing and charitable homes for the aged are facing financial crisis. According to OANHSS, six charitable homes for the aged have closed since 1987 due to deficits. In 30 homes, the total annual deficit has increased 125 per cent since 1987. The Ministry of Health recently allocated special funds of $8.1 million to ensure these facilities survive until January, when a new, needs-based funding formula will be introduced. It is intended to better match the actual care requirements of the 59,000 consumers living in long-term care facilities. 

Michael Klejman, executive director of OANHSS, agrees with helping seniors to stay in their homes. “But when the elderly and their care-givers in Ontario decide that facility-based care is the best option, they simply can’t get it,” he notes. “We know from experience that many of them remain in acute care hospital beds with a cost to the province of about four times what it would cost them to fund a long-term care bed. And many, unfortunately, remain in their own flats or apartments at considerable risk to themselves, isolated and dependent on a patchwork of services.” 

Beatrix Robinow, who worked on the Alliance’s report, was not impressed with the government’s initial plans, especially the proposed creation of 40 service coordination agencies whose mandate would be to control the delivery of home care services to seniors. Robinow thinks this would add to the confusion and just be another layer of bureaucracy. Many people who appeared at the Alliance’s public hearings expressed confusion over how the long-term care system worked. 

Robinow says that the government could save money by trimming the bureaucracy and using present organizations like the little-known District Health Councils. 

“District Health Councils have nothing to do with social services,” says Robinow. “But we want them to be expanded to include long-term care and general supervision of community services. We are waiting to hear if they are interested. I would urge the government to make sure that services are in place before pushing people out of institutions.” 

The health minister is cautious about the government’s next steps. “The Alliance’s report has been very helpful,” she says. “We are in the process of developing options. Two other ministers are involved and we also need to take this through Cabinet.

“Ontario is much larger and more complex (than other provinces). The range of services is more developed. We also have a mess in jurisdictions between municipalities and the province. And in Ontario there isn’t a concensus that this is the way to go. 

“We have been doing a lot of rationalization and streamlining for longer than other provinces. Most thinking people looking at the situation agree that doing nothing would hurt the system. It is not sustainable at present. You hear a lot of things about user fees. That would be the slippery slope for medicare. That would make people think they could buy better services.”

Ironically, user fees were recently endorsed by the Canadian Medical Association, suggesting the minister will have a fight on her hands with angry doctors. 

Amidst all the confusion, Dr. Perry Kendall was appointed on Aug. 24 as the provincial government’s special advisor on long-term care and population health. This veteran of both the City of Toronto as Medical Officer of Health – and the groundbreaking Victoria Health Project in British Columbia (often seen as the model for community services to seniors) seems well qualified. “One problem in the past has been the creation of smaller and smaller organizations every time somebody felt the system was not responsive to their needs,” he says. “This created organizational chaos. The challenge  now is to get all the organizations back together to share their expertise.”

Lankin says she hopes to have a conference on the reforms in the fall. 

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© David South Consulting 2021