Ontario Government To Review Out-Of-Country Health Coverage Program



    TORONTO, Jan. 30 /CNW/ - Elements of the Ontario Health Insurance Plan's
out-of-country health coverage program will be reviewed based on advice
received from Ombudsman André Marin, Health and Long-Term Care Minister George
Smitherman announced today.
    "Our government is committed to continue building a public health care
system that is responsive to the needs of Ontarians," Smitherman said. "We
appreciate the advice of the Ombudsman as it will assist us in our goal of
making the out-of-country health coverage program work better for Ontario
patients."
    The government will take immediate steps to provide physicians with
better access to information about the province's out-of-country health
coverage program.
    For Ontario residents traveling outside of Canada, OHIP covers only
emergency health services. Out-of-country elective medical services that are
readily available in Ontario are not covered by OHIP.
    Patients can receive prior approval from OHIP for out-of-country medical
services, if it is determined the services are:

    
    -   Not experimental and generally accepted in Ontario as appropriate for
        any person in the same medical circumstances as the patient
    -   Not performed in Ontario or performed in Ontario but necessary that
        the patient travel outside of Canada to avoid delay that would result
        in death or medically significant irreversible tissue damage.
    

    Other elements of the review will be implemented in the spring, and will
deal with additional issues raised by the Ombudsman including the need to
provide greater information about funding for particular treatments, to ensure
that decisions about funding for out of country treatment are consistent and
based on evidence and to improve the quality of reasons provided when requests
are denied.
    The Ombudsman's advice stemmed from the case of Ms. Suzanne Aucoin, who
was originally denied funding for out of country chemotherapy with the drug
Erbitux. Following the Ombudsman's investigation, the Ministry has agreed to
reimburse Ms. Aucoin for her costs.
    In communicating the decision to Ms. Aucoin, the Deputy Minister on
behalf of the Ministry of Health and Long-Term Care, apologized for the
difficulties Ms. Aucoin experienced in resolving this issue.

    This news release, along with other media materials, such as matte
stories and audio clips, on other subjects, are available on our website at:
http://www.health.gov.on.ca under the News Media section.

    For more information on achievements in health care, visit:
www.resultsontario.gov.on.ca.

    Disponible en français.





For further information:

For further information: Media Contacts: David Spencer, Minister's
Office, (416) 327-4320; A.G. Klei, Ministry of Health and Long-Term Care,
(416) 314-6197; Members of the general public: 1-866-532-3161

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Ontario Ministry of Health and Long-Term Care

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