Ontario reviews out-of-country health coverage

NEWS RELEASE

ONTARIO MINISTRY OF HEALTH AND LONG-TERM CARE

************************* Ontario government to review out-of-country health coverage program

Toronto, January 30 - Elements of the Ontario Health Insurance Plan's out-of-country health coverage program will be reviewed based on advice received from Ombudsman André Marin, Health and Long-Term Care Minister George Smitherman announced today. "Our government is committed to continue building a public health care system that is responsive to the needs of Ontarians," Smitherman said. "We appreciate the advice of the ombudsman as it will assist us in our goal of making the out-of-country health coverage program work better for Ontario patients." The government will take immediate steps to provide physicians with better access to information about the province's out-of-country health coverage program. For Ontario residents traveling outside of Canada, OHIP covers only emergency health services.

Out-of-country elective medical services that are readily available in Ontario are not covered by OHIP.

Patients can receive prior approval from OHIP for out-of-country medical services, if it is determined the services are:

- Not experimental and generally accepted in Ontario as appropriate for any person in the same medical circumstances as the patient

- Not performed in Ontario or performed in Ontario but necessary that the patient travel outside of Canada to avoid delay that would result in death or medically significant irreversible tissue damage.

Other elements of the review will be implemented in the spring, and will deal with additional issues raised by the ombudsman including the need to provide greater information about funding for particular treatments, to ensure that decisions about funding for out-of-country treatment are consistent and based on evidence and to improve the quality of reasons provided when requests are denied. The ombudsman's advice stemmed from the case of Ms. Suzanne Aucoin, who was originally denied funding for out of country chemotherapy with the drug Erbitux.

Following the Ombudsman's investigation, the ministry has agreed to reimburse Ms. Aucoin for her costs. In communicating the decision to Ms. Aucoin, the deputy minister on behalf of the Ministry of Health and Long-Term Care, apologized for the difficulties Ms. Aucoin experienced in resolving this issue.

*************************