Article submited by the Canadian Health Care Anti-fraud Association:

For almost 50 years a strong, publicly-funded health care system has been a cornerstone of the Canadian national identity. However, the health of that system is under threat from a combination of rising costs, resource shortages, mismanagement and fraud. In 2007, health care spending in Canada reached a whopping 168 billion dollars (Canadian Institute of Health Information Annual Report 2007). Despite these large-scale investments, maintaining a high quality of service continues to be a struggle.

Health care fraud is estimated at anywhere between 2% and 12% of all health spending. Even at the low end of the scale, this still amounts to billions of dollars lost each year. These lost resources could be paying for new medical equipment and for the hiring of more doctors and nurses to reduce wait times for treatment.

While acknowledging that health care fraud is committed by a few “bad apples,” it still represents a significant real dollar cost to our fragile health care system. Examples of health care fraud include:

1. Patients living in an American border town who use fake cards to take advantage of “free” health care in Canada.

2. People using another person’s health card to receive treatment.

These types of fraud generally involve individuals who do not meet the eligibility criteria for public health care coverage in a given province.

All Canadian jurisdictions have clear residency requirements for program eligibility, which often includes a primary residence within that province and a minimum live-in period. It is important for Canadians living abroad to be aware of these restrictions to ensure that they are receiving health care lawfully. Let’s look at this issue in terms of a possible real-life scenario:

John is retired. At 70, he and his wife decide that they need to move to a warmer climate. Mexico offers fantastic value, and there are communities of people much like themselves. They move south and are having a fantastic time until two years later when John’s wife Margaret falls ill. They are now in a situation that they hadn’t really planned for (who does?). Faced with health services that are not entirely up to Canadian standards and/or a prohibitively high cost of care, they decide it’s time to head back to Canada for treatment. Perhaps they are not aware that going back and participating in the health care system (which they have not paid into for two years) is illegal, or they rationalize it by thinking “Hey, we’ve paid into the system our entire life and rarely used it. Now it’s our turn.”

It’s understandable why John and Margaret might feel this way. Unfortunately the health care system is not designed like the Canada Pension Plan, which we pay into now and reap the benefits down the road. It’s also not set up as a portable lifetime benefit that can be relied upon anytime and anywhere. The fundamental issue is not a financial one but a matter of geography. John and Margaret will be eligible so long as they meet the residency requirements set out by their province.

Most provincial health plans extend eligibility to Canadians living/working abroad for a certain amount of time following their departure. For example, Ontario offers uninterrupted coverage to Canadians working abroad for up to five years and unlimited coverage for students studying overseas. For many expatriates, it may be a matter of making arrangements to reside in Canada for the amount of time necessary to retain their eligibility; this varies from province to province.   

The CHCAA encourages Canadian expatriates to familiarize themselves with the eligibility criteria set out by their provincial ministry of health. This information can be found online by visiting http://www.chcaa.org/blog/?p=78.  For shorter trips to Canada, you may also consider purchasing travel insurance, to ensure that you are covered for the time you are visiting the country.

Categories: Expat Life, Health, Other Articles
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