Safety of care

Improving patient safety and reducing risks

Responding to a patient without a health card

Originally published May 2018
18-09-E

Many physicians, especially those working in walk-in or primary care clinics, may find themselves in a situation where the person asking for treatment does not have a health card. Some institutions have policies to govern this situation, but in the absence of such a policy, you may 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 not, as a general rule, obligated to treat any new patient on an elective basis. The questions below may assist in deciding how to respond to a patient without a health card.

Is it an emergency?

Consider whether the patient requires emergency care. As a general principle, patients requiring emergency treatment should receive care first, with concerns about health cards being addressed later. This approach is consistent with the CMA’s Code of Ethics, which advises physicians to prioritize the well-being of patients,1 and to “provide whatever appropriate assistance you can to any person with an urgent need for medical care.” 1 CMPA members will generally be eligible for assistance with medical-legal issues arising from emergency treatment provided in Canada.

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. 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.

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-emergency care to someone without health coverage, you cannot discriminate in providing medical services on the basis of age, gender, 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-emergency 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.

Is the patient a non-resident of Canada?

If the patient has no health card, no alternate health coverage, and cannot prove 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-emergency 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.

For more information about treating individuals without a health card, or about the extent of CMPA protection in this situation, contact the CMPA for advice.




References

  1. Canadian Medical Association [Internet]. Ottawa (CA): CMA; 2004 (reviewed 2018 March). CMA code of ethics [cited 2018 March 5]; [1 screen]. Available from: https://www.cma.ca/En/Pages/code-of-ethics.aspx
  2. Potter v Korn (1995), 23 C.H.R.R. D/319, aff’d (1996), 134 DLR (4th) 437.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.