How to get Health and Medical Care in Toronto — Sharkhacks guide to Canada’s Health Care System

If you follow my blog then you probably know I have had my trouble with Canada’s health care system in the past. With that said I still think we have a decent health care system here.

First let’s start by stating that Canada has a publicly funded, private provided, health care system. What this means is that you have a Public Health Insurance which is handled at a provincial level (every province has their own insurance plan that is maintained by the ministry of health of that province). When you go see a doctor he/she files an insurance claim with the provincial insurance provider and they pay the doctor for the services he provided to you. This means you don’t pay the doctor yourself.

Where does the government come up with the money to cover health care cost?

From the taxes that they charge you, and me, and trust me they charge us a lot!

Who is eligible for this insurance?

Generally speaking any resident of Canada is eligible. If you are on a work permit you are considered, from a health care perspective, a temporary resident. (Still a resident, and still eligible for health care).

How does this insurance work ?

Since we agreed that this is a form of insurance, you need to prove to the doctor, hospital, etc. that you have insurance. To prove that you have insurance you need to obtain a provincial insurance card/ health card that you show your doctor on every visit.

WARNING : If you don’t have your insurance card you will be treated as if you don’t have insurance, and hence you will have to pay and cover the fees of the doctor, hospital, etc. out of pocket and you will NOT be reimbursed.

WARNING: Do not try to use someone else’s card to get health service. This is considered insurance fraud and you can go to jail for this!

GOOD TO KNOW : most provinces cover EMERGENCY medical services for FREE so if you are involved in an accident or if you have an emergency then most likely you will be treated in the hospital for free even if you don’t have insurance. Note that we are talking about Hospital here, not clinics or private doctors. If you go there, even for emergency, you will likely be charged a fee.

Where can I get my insurance card from?

For each province you can get the insurance card from the ministry of health for that province.

Here are the links to the ministry of health websites for all provinces. I will discuss Ontario (Toronto and the GTA) in depth below.

How do I get my health insurance card in Ontario?

ohip_health_card

The first thing you want to do after you land is to get your health insurance card, but wait, there is a catch. In some provinces (Ontario included) there is a mandatory waiting period from the time you land / become a resident/ move before you get the health insurance card. I believe this condition is there for a variety of reasons including proving your residency, and not just trying to trick the system to get free health care.

The waiting period for Ontario’s Health insurance Plan (OHIP) is three (3) months. What this means is that for the first three months you will NOT BE COVERED BY ONTARIO’S PUBLIC HEALTH INSURANCE PLAN.

What do I do then if I’m not covered by Public health for the first few months ?

Great question! You have two options:

Option 1 (Not recommended) : You can pay for your own health care. Paying the doctors, hospital, labs, etc.. etc.. when you need them. You may think taking this option will save you money but TRUST ME IT IS NOT WORTH IT… you don’t know if you will get sick, when you will get sick, you may be involved in an accident. This is life. Anything happens.

Option 2 (Recommended) : Buy private insurance. I highly recommend this option. In my case I remember I got sick when I got here , I bought private insurance for 500 dollars, my health care bills exceeded $CAD 1000, I had to do lab tests, etc.. I’m glad I took this option.

Where do I get private health insurance ?

There are many insurance providers. I recommend CoverMe by Manulife. There might be also services by SunLife. Both Sunlife and Manulife are reputable insurance providers in Canada so I recommend anything by these two. When you talk to their agent or try to do the insurance online choose the ‘Visitors to Canada’ insurance, not the one for Canadians traveling out of country. I know we said earlier you are a resident, but this is the correct insurance you need to get.

PRO TIP: If you are coming on a work permit and if you work for a good company then they typically will provide you with private health insurance which covers more than what public Health insurance covers (more on this below), it will also cover you during the period which isn’t covered by OHIP. Don’t take my word for it. Call the insurance company and double check what is covered and what is not in advance BEFORE you need it.

Alright I’m covered by private insurance, 3 month wait period is over, Where do I get my Ontario Health Insurance Card (OHIP) now?

Simple! You need to go to a Service Ontario Location. You can go to their website and lookup the nearest location to you that offers health card services (be careful there are Kiosks and other locations that do not offer that service so make sure you pick a location that offers health services). Usually when you pick a location it will show you also all documents that are necessary to bring with you. There is usually a form [PDF] you need to fill before going and print it out, and there is a list of documents that you need to bring with you such as your passport, work permit, proof of address , etc.. Here is the official list of documents [PDF].

WARNING: Bear in mind that requirements change all the time so make sure you consult Service ontario website not just my links above for latest form and instructions. Don’t blame me if you go to them with an old form. Go check their website!

WARNING : Some Service Ontario locations are more crowded than others. Ask someone who knows or might have gone through the process for a less crowded location. Also some centres might be crowded during certain hours. Try to avoid going at these hours if possible.

PRO TIP 1 : Some locations allow you to book an appointment instead of simply walk in to the location. If its available I highly recommend booking an appointment.

PRO TIP 2: Don’t think you are the only genius who is going to try to be there early, or go after hours. There are plenty of other geniuses like you! If you really want to be a genius pick the strangest hour (maybe 11am, 2pm, 3pm) where people are most likely at work.

So now I’m on OHIP. What is covered and what’s not?

With OHIP you get the basics of health insurance. The following additional services are NOT covered by OHIP.

  • prescription medications
  • dental care
  • physiotherapy
  • ambulance services
  • prescription eyeglasses

PRO TIP 1: Most companies who offer their employees private extended coverage, will usually have the above additional expenses covered by the private insurance plan. Check your employer’s health insurance provider and what they cover.

PRO TIP 2: This is more of a TAX tip (will be covered in Sharkhacks tax guide), however keep in mind that you can use your health care expenses/ medical expenses to reduce your taxes. This is especially helpful if you don’t have private / extended insurance coverage as your medical expenses are likely to be high.

Alright now I have my OHIP coverage, what do I need to do next?

To explain this I have to explain the types of health care options that you have.

If you are involved in an emergency such as accident do what they do at the movies! Call 911 from the nearest phone.

911 will then send an ambulance and route you to the nearest hospital.

If you are involved in an emergency but you are still conscious, and can drive, or be driven, then drive to the nearest hospital. Go to the Emergency Room (ER)

A word of warning here. If your case is not critical, not really an emergency, then I highly recommend AGAINST going to the ER. One of the shocking things about ER is that there is crazy amount of waiting time, and patients are sent in based on emergency level and priority.

I have been to the emergency a number of times and I can tell you my average waiting time has varied between 1 and 3 hours before I went in to see a doctor. A nurse will typically triage you first, run some tests, and then decide how soon you should go in. This is a great approach to make sure the more urgent cases are handled first, but if you have a broken leg, or twisted ankle, you probably have to wait a couple of hours.

If you have some symptoms, urgent, but not emergent, and not life threatening, and you don’t have a family doctor, or cannot get an appointment with your family doctor soon enough then go to a walk-in clinic.

Walk-in clinics are considered urgent care clinics. They have doctors available during the day (9am to 5pm) with some that have after hours or extended hours (5 pm to 9pm). These clinics are typically a bit less crowded than the ER, but still have a lot of people coming in. The way it typically works is that you go in, ask to see a doctor, they will see your health card, register your name, then you have to wait in line for your turn. You can go in, see the doctor, if there are health tests that need to be done, they will either give you a paper that you take to a lab, or do the necessary draws (blood, urine, etc..) themselves. They will send your results to lab and only call you back if there is an issue. If there are no issues you will not hear from them again. If there is you will be asked to come and see the doctor again. In case medication is required the doctor there will give you a prescription.

Pro tip: If I’m waiting on lab tests I like to take matters into my own hands and not wait for them to call or not call or miss my file. I would call them and make sure they actually received my results and that the doctor has reviewed them. They should be able to tell you this on the phone without you having to visit them. This way I ensure that my test results are back and have been seen. Not that they have been lost somewhere in the system. Do I think there are tests lost and people fall through the cracks? Hell Yea !! so i won’t take that risk.

Pro tip: While walk-in clinics are great for urgent situations, they do NOT offer continuity of care. This means if you have an on-going medical condition (such as blood pressure, diabetes, etc. etc.) then these doctors will not be able to follow up with you. Why? because doctors rotate. Today you might get one doctor, tomorrow it is another, they might even change hourly.

Mission Impossible… AKA finding a good family doctor in Toronto!

Mission Impossible

As we said above. Everyone deserves continuity of care, and your family doctor definitely should have a higher standard of care for you. Your family doctor should run annual physical tests on you. Do health checks, blood checks, give you and your family immunizations, and should be aware and involved in every medical situation you encounter. Think about it this way. You might go 10 times to a walk in clinic, and since they don’t have a consolidated view of you, and your different emergencies, they cannot see the big picture. You might go complaining of one thing today, another tomorrow, these might be related, but these doctors will not be able to see the relationship as they don’t have access to your entire story and file.

How do you find a GOOD family doctor?

I say this with a heavy heart but I think your first challenge will be finding ANY family doctor. If you find one you gotta hold on to him as much as possible until you find the ONE. These folks are as rare as unicorns!!

Method 1 : Ontario / Toronto has a special program (used to be called Health Care connect) where they try to match you with a family doctor or nurse practitioner. You can try your luck with this program. Register here and they will notify you once they find a unicorn. I registered and for a whole year I didn’t get anything from them!! damn you health care connect!!

Method 2: Ask your friends or family members if they know a family doctor that is ACCEPTING NEW PATIENTS. This is what makes finding a family doctor impossible. There are plenty of them but most of them are already fully booked. Each family doctor has a certain number of patients that he is capable of handling. Once that number is exceeded the doctor will stop accepting. I believe method 2 is more effective. If your friend knows a doctor well, the doctor, as a favour might not turn your friend down and he will accept you if you are lucky.

Why is it so damn hard to find a Family doctor, let alone a good one?

Let me tell you a story. When I got here few years ago I was desperately trying to find a family doctor. I googled and googled. Each time I found a doctor and called him he said he isn’t accepting new patients. I once made a list, ON ONE DAY, of 32 Doctors and their phone numbers. I called them ALL. NONE WAS ACCEPTING new patients!!!!!!!!

Here is my theory : Family Medicine is lame! If you are a hot shot doctor who recently graduated and eager to take on the world would you go cure cancer, do surgery, save lives, or would you run a clinic and deal with people with flu and diarrhea all day? If i were a doctor this is probably how i will think. If you are a doctor who got tired of the long hours, and looking for a work / life balance, and don’t want to work too hard then you will open a clinic. With this option you can control the influx of patients and the hours. I have not run this theory past the doctors I know yet, but will do soon.

Pro Tip: I’m never going to ask my new family doctor about this theory as I don’t wanna piss him off. I just found him last week for God’s Sake!! If you find one don’t run this theory by him!

Besides my less scientific theory I think there are some other issues :

  1. There is generally a shortage of doctors and health care practitioners. Canada’s Education system is not churning out doctors fast enough. And we are not attracting foreign doctors fast enough.
  2. Current doctor population is aging and retiring fast.

What Do I do if I followed all this and I still cannot find a family doctor ?

Keep trying. Don’t give up. and Most important is …

Don’t stop believing !