Is health care priceless? Not quite. For hundreds of thousands of Ontarians, a visit to the emergency department will now cost hundreds of dollars just to walk through the door. Need someone to run a lab or take a CT scan? Add another few hundred dollars. A routine visit can easily add up to nearly $1,000.
Uninsured patients must weigh their ability to pay against meeting their other basic needs. Groceries for the family, or going to emergency for a possible heart attack? Paying this month’s rent, or getting a CT for worsening abdominal pain? Diapers for the new baby, or seeing someone for postpartum depression? These are the choices that have become a reality for the uninsured since the Ontario government ended their coverage on April 1.
In March 2020, the Ontario government began covering medically necessary services for uninsured patients – a long overdue measure to protect public and community health. In March 2023, without consultation from health-care professionals, the government announced that the program was ending. As health-care providers, health-equity researchers and community health leaders, we know from our research and first-hand experience that the plan to stop hospital and physician payments for medically necessary services for uninsured individuals is short-sighted and irresponsible.
The government has a responsibility for the health of uninsured individuals, who are amongst the most vulnerable people in our country. Prior to 2020, more than half of uninsured pregnant women were found to have clearly inadequate prenatal care. Uninsured children presented more often for injuries, trauma and mental health concerns than other children. When previously uninsured people were provided with coverage in the United States, their health significantly improved. Conversely, in Spain, restricting access for uninsured patients to health care led to an increase in the mortality rate.
If we extrapolated this data to an Ontario context, this would mean 1.5 more uninsured people dying every month because our government decided to end their access to health care. In a paper published in the Canadian Journal of Emergency Medicine by our study team, the overwhelming response from health-care providers was that the most effective way to improve care would be to make permanent the temporary extension of health coverage to uninsured patients enacted during the COVID-19 pandemic. The government did the opposite.
We know that this decision will mean that burned out health-care providers will be left to manage the systemic gaps created by short-sighted policies.
We know that the result of this decision will mean that burned out and overburdened health-care providers will be left to manage the systemic gaps created by short-sighted government policies. As health-care providers, we have moral and ethical obligations to provide care to all patients regardless of their insurance status. However, caring for this population can lead to moral distress as providers are forced to balance treatment costs and therapeutic benefits against the economic shortfalls that delivering these interventions may impose. This policy may force uninsured people into only seeking care when it is most emergent, which is the point when it is most emotionally taxing on our health-care providers and most financially taxing on our system. As health-care providers, we are simply asking the government to give us the tools and resources that we need to do our job.
Lastly, these actions beg the question of whether the government is infringing upon the universality of the health-care system, a fundamental Canadian ethos. By denying public health care to uninsured individuals, we create a two-tiered system that devalues the lives of uninsured individuals and perpetuates health disparities. If we, as a society, are to move toward an equitable future while upholding the integral tenets of our past, we need to walk together and not opt to leave the most vulnerable behind.
So, what is the price of a human life?
We strongly recommend that the Ontario government reverse its decision to eliminate coverage for medically necessary services for uninsured individuals. We urge the government to prioritize the health and well-being of all Ontarians, especially those who are most vulnerable. The government may stand to learn from our health-care principle to “do no harm.”