OHIP's Bureaucratic Wrangling

The Canadian health care system is not quite in a parlous state. Most Canadians from whichever province they receive their health care are assured of fairly timely interventions and surgeries. Hospitals are crowded and there are some inconveniences in the public system over strained by the burden of attending to the health needs of a large population, but by and large most Canadians would agree it's a good universal health care system.

And most Canadians who have made use of the system are at the very least reasonably satisfied with the care they've received. Recent statistics reveal that cancer outcomes in Canada are at the top of the international game; survival rates for various types of cancer, for heart attacks and stroke, are measurably good.

Emergency room waits are broadly speaking, too long and improvements should be made in that area.

But Canadians have access to top-notch health professionals and surgeons who really know their business. There may not be as many diagnostic high-profile, space-age technical devices available as there are in other countries like the United States, but the universal health care mandate in Canada remains one that most Canadians are proud of.

Every now and then, however, an incident occurs that makes the public shake its collective head in disbelief. As in the case of Suresh Kapur who was diagnosed with bleeding on the brain when he presented at a Toronto hospital with symptoms including headaches, vomiting and imbalance. And then was granted an "urgent" follow-up appointment with a neuro-surgeon - in three days' time.

Mr. Kapur did what any intelligent, informed and capable person would and should do; he sought an immediate 'second opinion'. He had the benefit of family members in the health profession, who also advised him. So the 70-year-old retired engineer went directly to Buffalo, New York within the same day, where doctors there rushed him immediately into an operating theatre, and thereby doubtless saved his life.

Post-surgery when Mr. Kapur applied to the Ontario Health Insurance Program to pay his hospital bills, they refused; his trip to Buffalo and the subsequent surgery had not been pre- authorized. OHIP, as it happens, routinely sends Ontario patients to Buffalo for emergency neurosurgery, but Mr. Kapur, whose medical bills came to roughly $100,000 hadn't been pre-authorized.

In a bureaucracy, this makes sense.

In a society that cares for its population requiring urgent medical care it does not. The government of Ontario has undertaken to provide an additional $400,000 to each of the province's neurological centres to assist in handling more patients, but the problem is insufficient operating theatres and associated hospital beds.

The good news story for Mr. Kapur is that he has succeeded in his year-long battle to have OHIP cover his U.S. medical-hospital costs. As though there would possibly be any other reasonable option.