Health Care is Not Free – A Call for an Element of Patient Accountability


Many people think health care in Canada is “free.” This is not true.


In Ontario, many of the medical services that patients receive are paid for by OHIP (the Ontario Health Insurance Plan).Health Dollars


OHIP is different from most insurance plans, though. Think of your car insurance, for example. If you have an accident, you must first pay a deductible before the insurance company pays to repair your vehicle. For example, if the total cost to repair your car is $3000, and if your insurance deductible is $500, then you must pay the $500 deductible and then your car insurance pays the remaining $2500. The deductible is the amount of cost (risk) that a person takes responsibility for. It prevents misuse and overuse of car insurance plans so that people do not make claims for every single stone chip. Otherwise, the total cost of the insurance would need to be much higher in order pay for all these additional claims.


OHIP is an insurance plan for medical services, but people do not have to pay a deductible before they have OHIP pay for something. Another way to think about this is that the deductible for using OHIP is zero dollars ($0). This is also known as “first dollar coverage.”


OHIP is not an infinite pot of money. The money that funds OHIP comes from people paying taxes. This a limited amount of money. Any amount of payments that go over this limit runs OHIP and Ontario further into debt. Not only that, but doctors’ time is limited. Every visit that someone uses potentially takes up time that could have been used for another patient.


Given the above, even though there is no deductible ($0) to have OHIP pay for health services, every Ontario citizen still has a social duty to use OHIP appropriately so as not to overburden the health care system and our economy. This is a crucial element in patient accountability.


Therefore, before going to see a doctor, pretend to ask yourself:


“If I had to pay $5, or $20, out of my own pocket for this doctor visit, would I still think it is necessary?”


Are there things you could try on your own before seeing the doctor? Is this something that may simply need a little more time to improve on its own?


The same types of questions should apply before going to the ER, or to see a specialist, or to ask for tests such as blood work or x-rays.


Sometimes patients book visits with their family doctors just to “check in.” Before you book a visit with your doctor, please make sure you have a specific question or issue that you need to discuss. If you do not have an actual medical concern, is this visit really the best use of your doctor’s time and OHIP dollars? If you simply have a question, is this something that you could simply phone in and ask, rather than booking an actual appointment to see your doctor in person?


Sometimes patients book visits with their family doctors to “follow up from a specialist visit.” Often, the patient simply wants to update the family doctor what happened at the specialist visit. These types of visits are not needed. Please be assured that your specialist will send a note to your family doctor that summarizes your visit.



If you are thinking of going to see the doctor to follow up from a previous visit because your issue still has not resolved, pretend to ask yourself:


“Have I done everything that my doctor suggested from last visit?”


If not, then why not? Sometimes there will be valid reasons or barriers that you need to explore with your doctor, but if not, then what additional advice are you hoping for when you see your doctor this time? If your doctor had a miracle cure or easy fix, he/she would have already suggested that at the first visit. If you have not tried everything that was suggested from the first visit, then your doctor is likely to simply repeat the same advice. So, is this visit really a good use of limited OHIP dollars?



Another key question to ask yourself before you follow up with your doctor:


“Have I allowed the enough time for my problem to improve?”


Medical issues usually take time to improve, even with treatment. If your doctor suggested that it may take a month to improve, is it reasonable to book a visit to follow up after only one week? As above, what additional advice are you hoping for if go to see your doctor sooner than was suggested? Again, is this visit really a good use of limited OHIP dollars?



There are many people who already appreciate these concepts. However, some people are unaware. If everyone starts to consider these things, then it will go a long way to improve our health care system.



— Dr. Adam Stewart

August 7, 2016