Guest Editorial

Land of free healthcare

I recently diagnosed an elderly Iranian man with colon cancer. He'd come to Canada over 18 months ago to visit his daughter and showed up at the hospital with exertional dyspnea and severe iron deficiency anemia. After receiving a blood transfusion and a diagnosis of colon cancer, which was confirmed endoscopically, he immediate returned to Iran for bowel resection. To date, neither he nor his family have paid my fee or the hospital fee for his medical care. We were left high and dry without even a forwarding address in Iran.

In the last three months, I've been involved in the medical care of three foreign nationals visiting Canada who either could not or would not pay their medical bills. The hospital administration hopes to recoup at least some of the expenses incurred in all three cases — but the administrator I spoke to wasn't optimistic.

There are those who would suggest that medical care shouldn't be offered to non-Canadians under any circumstances — unless they provide proof that they're able and willing to pay for it. But it would be unethical, both morally and professionally, to deny individuals access to health services, especially if they wind up in the emergency room and need urgent medical care. Our job as physicians is to heal those in need.

On the other hand, Canada can not and must not develop an international reputation — as I fear it might well have already — as a nation where anyone can come, visit and not have to take financial responsibility for their medical care. There are various possible solutions to keep us from being stiffed. Visitors could be required to present evidence of medical insurance before entering this country, and perhaps this should well become a criterion before issuing a visitor's visa. Another option might be to collect a 'medical insurance tax' from all foreign nationals at points of entry into Canada, or when airplane tickets are purchased abroad.

A small amount from every visitor who does not use — or abuse — the health system would provide funds to cover the cost of health resources used and never recouped.

Many countries already charge exit taxes on leaving the country, so Canada would not be unusual in this respect. We can still maintain our reputation as a humanitarian nation, but do it a little more cleverly. I'm eager to hear what other physicians have to say on the subject, so please write in.

— Robert Fingerote, MD