Americans Filching Free Health Care in Canada
Published: December 20, 1993
Lacking a national health care system of their own, thousands of Americans are tapping into Canada's --
illegally.
"It's not an epidemic in any one person's practice," said Keith MacLeod, an obstetrician in Windsor, Ontario, across from Detroit, "but I would estimate that from 12 to 20 of my patients at any one time are ineligible Americans. And I'm just one of 520 doctors in Windsor, 23,000 in Ontario."
Dr. MacLeod, former president of the Essex County Medical Society, delivers about 400 babies a year.
A report prepared for Ontario's Health Minister indicated that from August 1992 to February 1993, 60,000 medical claims had been made on behalf of patients who held American drivers' licenses.
The total number of improper claims in Ontario was estimated at 600,000.
Only legal residents qualify for free medical care in Canada, using plastic health cards for identification. Others are supposed to pay for medical services they may require, but many are submitting counterfeit, borrowed or fradulently obtained cards.
Loopholes and the lack of stringent controls are costing the provincial health care system as much as $691 million a year, the Ontario report found.
"The ministry is open to the fraudulent use of health care in all programs," the report said. "Almost no analytical tools exist at this time, and lenient registration policies encourage abuse by non- and new residents."
Joseph Cordiano, chairman of the Public Accounts Committee of the Ontario Legislature, added, "Fraud is squandering our resources."
Although the encroachment is largely a border phenomenon, it has national scope because more than 90 percent of Canadians live and work within 100 miles of the United States. Other provinces have similar problems, but Ontario's size has given the issue national prominence.
In Canada, policing health care was always seen as more trouble than it was worth, and the authorities have long ignored cracks in the system. Doctors have little desire to be secret informers, and strict patient confidentiality laws have helped seal their lips.
And for years Canadians widely believed that their country was rich enough to look after all those who entered its portals.
But times are changing. In an era of mammoth budget deficits, to which free health care is a leading contributor, politicians of all stripes are eagerly seizing on ways to save money.
"In the past, we didn't pay enough attention to who was an Ontario resident," said Health Minister Ruth Grier, a member of the socialist-oriented New Democratic Party, which governs the province. "But now we have to make sure that we spend taxpayers' dollars as wisely as possible."
The provinces run Canada's health care system, which takes roughly a third of their budgets and is financed by payroll taxes, federal transfer payments and periodic borrowing.
About a quarter of the $17 billion spent on health care in Ontario, the richest and most populous province,
is borrowed in the form of bonds sold to investors, many from the United States. The recent downgrading of Ontario's debt by two leading bond-rating services has suddenly raised the province's borrowing costs, thus compounding its financial problems.