Health Card Fraud & Other System Failures
By Julie Taub
[Note: Ms. Taub identifies four immigration-related ways to improve Canada's Health Care system: parts 1,3 and 4 deal directly with immigration; part 2 deals with "doctor shopping" and presumably involves both long-term Canadians as well as legal or illegal immigrants.]
ALSO READ: More Health Cards Than Clients
Waiting times, shortage of doctors—–health care is a pressing concern to all Canadians. There are countless articles on how to reform health care: inject more money, repeal the Canada Health Act, privatize, combine private public etc. The suggestions and criticism are endless…………………………………………………………….
But the obvious, most fundamental problems, which would be simple to address and not require changes in the law or a huge injection of tax dollars to implement, are overlooked.
[Part 1] Has any politician ever thought to investigate whether everyone on the waiting lists, emergency departments, doctors’ offices is really eligible for health care?? Having a health card means little because there are hundreds of thousands of fraudulent [health] cards; the government of Ontario distributed 500,000 (!) too many under the Conservatives. In Ontario, the majority of health cards have no pictures, such as mine until several weeks ago. Thousands have obtained health cards fraudulently in Ontario and I am sure across Canada. Americans living near the border can rent or buy health cards. Some permanent residents and citizens rent or lend their cards to friends or family who visit them from abroad. I am an immigration lawyer, and some of my clients have confirmed that this practice is rampant. (Editor’s Note: Former B.C. MLA David Schreck has recently pointed out B.C. irregularities similar to those in Ontario.)
It is not a monumental task to enforce the existing legislation to avoid fraud. Ensure that ONLY Canadian citizens, permanent residents and legitimate foreign workers have access to our health care system. In addition to presenting a health card, each user should provide proof of being a citizen or permanent resident of Canada. This is not onerous because since December 31, 2004 all permanent residents are required to have PR cards. A passport, citizenship card or birth certificate (with photo I.D.) easily confirms citizenship. No new laws would be required for this confirmation, merely enforcing existing laws that limit health care to citizens and permanent residents. Refugee claimants are well documented and do not have health cards. Their health care costs are covered directly by the federal government, so they are not part of this problem. Rather than investigating individual cases that may come to the attention of authorities after the fact, it would be far more efficient and cost effective to prevent such fraud in the first place.
An ounce of prevention is worth a pound of cure. Pouring millions of dollars into the existing health care system without addressing this massive costly abuse is like installing a high efficiency furnace in one’s home but leaving the windows wide open in winter.
[Part 2] There is a second area of abuse that is widespread and acknowledged: the overuse of the medical system by users who engage in doctor shopping. In order to get narcotics such as codeine, abusers will visit several different doctors to get multiple prescriptions for their personal addiction or for trafficking. [Also] patients who visit several different doctors for an ailment may end up with several different prescriptions, which, in combination may be deleterious to their health or even fatal. Then of course there are those who go from doctor to doctor until they get a diagnosis and treatment that they want, even though it is not necessary.
Digitizing medical records of each patient would make the system more efficient by permitting a doctor’s immediate access, with a password, to a patient’s medical history. This would curb abuse, multiple prescriptions and errors in over prescribing medication to patients, essentially abolishing doctor shopping. It would also improve waiting times and facilitate diagnosis and treatment or simply help narrow down or eliminate a diagnosis on the exhaustive list of differentials. Imagine having a patient’s previous CT or MRI on-hand when a potential stroke patient comes into the ER. Or imagine an unconscious patient being brought to ER and discovering immediately that they have diabetes and a history of hypoglycaemic episodes. It will also help bridge the gap in communication between health care facilities. Hospitals and clinics are over crowded with patients’ paper records containing their health care information, which could be scattered anywhere from Ottawa to Toronto to Thunder Bay! Imagine the money saved on couriers, phone calls, faxes to obtain patient information, not to mention PAPER!
Critics of this on-line system cite the invasion of privacy, yet on-line banking that puts clients’ entire financial profiles on-line doesn’t seem to elicit the same fear-mongering.
[Part 3] The shortage of doctors can be partially addressed with the reduction of the number of foreign graduate residency placements in Canadian teaching hospitals. A significant portion of residents in most Canadian teaching hospitals are foreign medical graduates, particularly from Middle East countries, excluding Israel. The medical schools charge about $40,000 to $50,000.00 a year for each spot, enough to cover the training expenses. There are now approximately six hundred Saudi Arabian doctors getting their residency training in [our] Canadian system, along with some 300 from other countries, mostly from the Middle East. That represents about 10 per cent of all residency spots. Significantly, the Canadian Medical Association says the Canadian medical system needs about the same number of new Canadian residency spots as what the foreign doctors are buying, that. Plus, the CMA says, the medical schools need more funding, to produce the doctors to take that training.
Only the medical schools benefit from these tuitions. A significant proportion, if not the majority of residents in surgery, orthopaedics, emergency and other specialities, are Saudi, Libyan, Kuwaiti and other foreign graduate doctors who return to their countries upon completion of their 5 year resident programmes at major urban Canadian hospitals. Canada does not benefit in any way from these placements; on the contrary this may be a significant contributing factor to the shortage of doctors. As a result, our medical graduates compete for fewer residence placements.
The doctors in the hospital who train these foreign doctors do not get any compensation. Our Canadian residents also have to compete for training and attention from the attendees with these foreign medical graduates. The entire country is lucky to get a very limited number of new orthopaedic surgeons a year, because the majority are foreign graduates who return to the Middle East. In many hospitals, the surgical residents are often referred to as the “Saudi or Libyan team”
The solution is simple: that 10% (currently occupied by non-Canadians) should be reserved for Canadian doctors or immigrant doctors who will remain in Canada. If and only if there are surplus residence placements available afterwards, then and only then should the medical schools accept foreign medical graduates.
[Part 4] Immigrant foreign trained doctors: Unfortunately, multiculturalism interferes with granting Canadian medical licences to foreign-trained doctors in an efficient manner. It is not politically correct to state that not all foreign-trained medical doctors are equally proficient. We all know that medical standards around the world are not the same. Yet Canada insists on treating all foreign trained doctors the same. For example, it is well known that Western European, Israeli, Cuban and Japanese medical standards and training are far superior to those in third world countries. The provincial governments should recognize the obvious and vary the length of residency training accordingly. This would allow Western-trained foreign doctors to enter medical practice sooner.
[Editor's Note: While all this fraudulent health care acquisition, costing tens of million$ of our tax dollars (not to mention organized crime activities) is happening right "under our noses", O.P.P. Commissioner Fantino and his minions think it's more important to focus on 'soft targets' such as Ontario drivers who fail to buckle their seatbelts as in the previous article [or HERE], where less than 1% of drivers stopped for inspection were not complying with this revenue-gathering law.]