Many physicians, especially those working in walk-in clinics, may find themselves in a situation where the person asking for treatment does not have a health card. Unless your institution has specific policies to govern this situation, you might have to make your own decision about whether to provide care.
While you can choose to provide care to someone without a health card, you are generally not obligated to treat any new patient on an elective basis. Here are some questions to consider when responding to a patient without a health card.
Is the need for care urgent?
If the situation is an emergency, or if the patient requires urgent care, then care should be provided first, with concerns about health coverage being addressed later. This approach is consistent with the CMA’s Code of Ethics and Professionalism.1 CMPA members will generally be eligible for assistance with medico-legal issues arising from urgent treatment provided in Canada. For in-depth information about providing emergency care on airplanes or in foreign jurisdictions, see our article about acting as a good Samaritan.
Can you verify health card status?
If the patient has lost or forgotten their card, it may still be possible to verify their health insurance information. For instance, in Ontario, the Ministry of Health and Long-Term Care will provide health card numbers to physicians who submit a Health Number Release form signed by the patient. Physicians can consult with the ministry of health in their jurisdiction to see whether similar processes exist for verifying health card information. Note that physicians can choose to provide care to patients who have valid health cards from other provinces or territories.
Does the patient have federal or private health insurance?
A patient without a health card may be insured through other means. For example, individuals who are refugee claimants or resettled refugees may be covered under the Interim Federal Health Program (IFHP), while others may be covered under private insurance plans.
Individuals with federal or private coverage should be treated like any other prospective patient. Your decision to provide care will depend on whether you are accepting new patients and whether you are qualified to provide the care requested.
Are you treating all prospective patients equally?
While you do not have an obligation to provide non urgent care to someone without health coverage, you cannot discriminate in providing medical services on the basis of age, gender, sexual orientation, national or ethnic origin, or any other ground listed in provincial or territorial human rights legislation. As the BC Council on Human Rights stated in Potter v Korn (1995),2 a physician is not required to treat every patient who comes in the door, but the decision not to treat cannot be exercised in a discriminatory manner.
If you decide not to treat patients without a health card or alternate coverage, the decision should be made in non-urgent situations only and in a way that affects all prospective patients equally. Patients should have the decision explained to them, and understand why care is not being provided. You may also wish to consider referring the patient to a medical clinic that serves patients who do not have health insurance.
Is the patient a non-resident of Canada?
If the patient has no health card, no alternate health coverage, and cannot demonstrate provincial or territorial residency, he or she may be a non-resident of Canada. Non-residency is significant, because it may affect the extent of CMPA protection. Members who provide non-urgent care to non-residents, or who solicit non-residents as patients, may not be eligible for CMPA protection if an action is commenced in a foreign jurisdiction. More information about non-residents and the extent of CMPA protection is available in the articles listed below.
To learn more about treating individuals without a health card, or about the extent of CMPA protection in this situation, contact the CMPA for advice.
References
- Canadian Medical Association, “CMA Code of Ethics and Professionalism,” 2018. Accessed August 2022 from: https://www.cma.ca/cma-code-ethics-and-professionalism
- Potter v Korn (1995), 23 C.H.R.R. D/319, aff’d (1996), 134 DLR (4th) 437.
