The Difference a Few Days Make

Ministry of Health and Long-Term Care

Date: 2007

The Ministry of Health and Long-Term Care’s Ontario Health Insurance Plan (OHIP) stipulates that people moving to Ontario who have been out of the country for more than seven months must wait three months before the province will cover their health care.

On Aug. 17. 2006, the Ombudsman received a complaint made by the daughter of a 94-year-old man. Her father, a Canadian citizen and World War II veteran, had moved to the United States after he retired. When she had to bring him back to Canada to live with her on very short notice, she asked the Ministry what she should do to ensure he had health coverage during the three-month waiting period. She was advised to get private insurance, but given her father’s age, this was not an option.

The man moved into his daughter’s home, where, 38 days before his OHIP coverage was to begin, he fell and broke his hip. The daughter was told he would die without surgery. At the end of his lengthy hospital stay, he was left with a bill for over $35,000, which the hospital allowed him to repay through small monthly deductions from his pension – although it advised the daughter it would go after his estate for the rest of the bill after his eventual death.

The Ombudsman investigated the complaint and submitted a preliminary report to the Ministry of Health and Long-Term Care, recommending it consider making an exception in the man’s case based on compassion, decency, and fairness. He pointed out that Ministerial discretion exists for such cases, despite one Ministry official’s assertion that the OHIP provisions are “black and white.”

The Deputy Minister of Health and Long-Term Care subsequently confirmed to the Ombudsman that the hospital had waived the bill. Within a few weeks, the hospital sent a cheque returning the money already paid. The complainant, who had never told her father of the debt due to his fragile health, was extremely pleased with the outcome.

- Annual Report 2006-2007