Frequently Asked Questions
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OHIP
OHIP stands for the Ontario Health Insurance Plan, which covers a variety of essential health services in Ontario. You will need to show your OHIP card every time you see your doctor, visit an emergency room or walk-in clinic, have a medical test or go for surgery. The government of Ontario covers these expenses directly
SOURCE:
Health care in Ontario, Ministry of Health, 12 Jun. 2023, https://www.ontario.ca/page/apply-ohip-and-get-health-card#section-0. Accessed 7 Dec. 2023.
Public health care systems, like OHIP, cover around 70% of health care costs in Canada. Each province operates a little differently in terms of what services are covered.
OHIP provides medical necessary services like doctors’ visits, hospital care and diagnostic tests. But some treatments, procedures and prescription medications may not be included. In those cases, supplemental insurance (such as from your employer) may cover those fees.
OHIP covers:
- Doctor visits
- Hospital visits and stays
- Eligible laboratory tests is community labs or hospitals
- Eligible dental surgery (in a hospital)
- Eligible eye-health/optometry services
- Eligible podiatry (foot services)
- Ambulance services
- Travel for health services if you live in Northern Ontario
SOURCES:
What OHIP Covers, Ministry of Health, 3 Nov. 2023, www.ontario.ca/page/what-ohip-covers. Accessed 7 Dec. 2023.
Desoutter, Alexandre. What Is Ohip? All about the Ontario Health Insurance Plan in 2023, HelloSafe, 9 Aug. 2023, www.hellosafe.ca/en/health-insurance/ontario/ohip. Accessed 7 Dec. 2023.
OHIP does not include:
- Prescription drugs (in non-hospital settings)
- Paramedical services including chiropractors, massage therapists, naturopaths, acupuncturists and osteopaths
- Many birth control methods
- Dental services provided in a dentist’s office
- Eyeglasses and contact lenses
- Laser eye surgery
- Cosmetic procedures and many dermatology services
- Immunizations for travel
- Most physiotherapy
- Eye exams for people between 20-65 without specific eye conditions
- Necessary emergency medical treatment obtained outside of Canada
SOURCE:
10 Services Not Covered by OHIP: What You Need to Know: HQ, HealthQuotes, 25 Oct. 2023,www.healthquotes.ca/10-services-not-covered-by-ohip-what-you-need-to-know. Accessed 7 Dec. 2023.
To be eligible for OHIP you need to make Ontario your primary residence and physically be in Ontario for 153 days in a 12-month period.
You must also meet at least one of the following criteria:
- Be a Canadian citizen
- Be an Indigenous person under the federal Indian Acy
- Be a permanent resident
- Applied for permanent residence in Canada
- Be in Ontario on a valid work permit and are working full-time in Ontario for an Ontario employer for at least six months
- Be a convention refugee or other protected person (as defned by the Immigration and Refugee Board of Canada)
- Have a temporary resident permit
- Be a clergy member who is legally in Canada and will be full-time ministering in Ontario for at least six months
Additional information is available at www.ontario.ca.
SOURCE:
Who qualifies, Ministry of Health, 12 Jun. 2023, https://www.ontario.ca/page/apply-ohip-and-get-health-card. Accessed 7 Dec. 2023.
Roughly 75% of OHIP is funded by taxpayers and businesses located in Ontario.
The remaining 25% of OHIP costs are covered by the Government of Canada through the Canada Health Transfer as part of the Canada Health Act.
SOURCES:
Health Premium, Ministry of Health, 2 Nov. 2023,https://www.ontario.ca/page/health-premium. Accessed 7 Dec. 2023.
Canada's health care system, Government of Canada, 10 Oct. 2023, https://www.canada.ca/en/health-canada/services/canada-health-care-system.html. Accessed 7 Dec. 2023.
Healthcare in Ontario: How does it Work and How is it Funded?, Closing the Gap Healthcare, 18 May. 2018, https://www.closingthegap.ca/healthcare-in-ontario-how-does-it-work-and-how-is-it-funded.Accessed 7 Dec. 2023.
To receive funds from the Government of Canada, the Ontario Ministry of Health must follow the Canada Health Act (CHA) which requires health care policy to "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers." There are criteria and conditions related to health services that each province and territory must fulfill to receive funds.
SOURCE:
Canada Health Act. Government of Canada, 10 Mar. 2023, https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html. Accessed 7 Dec. 2023.
Bill 60 and Privatized Health Care
On May 8, 2023, the Conservative-led Ontario government passed Bill 60, Your Health Act. Bill 60 will allow:
- the government to deregulate certain health professions by making changes to the definitions of numerous positions including Physicians, Registered Practical Nurses and Registered Nurses;
- the creation of an unlimited number of private clinics with licenses to provide OHIP-covered services;
- permit private clinics to actively upsell uninsured services and charges to patients.
There are concerns that Bill 60 will worsen the staffing crisis and wait times in our public health care system by pulling funding and staff from it. These concerns are based on historical evidence from when other countries have moved from a single-tier health care system to a two-tier one.
SOURCES:
Bill 60: What You Should Know. OPSEU SEFPO, 12 May 2023, www.opseu.org/news/bill-60-what-you-should-know. Accessed 7 Dec. 2023.
Analysis: Ontario Health Coalition Analysis of Bill 60, Your Health Act. Ontario Health Coalition, 4 Apr. 2023, www.ontariohealthcoalition.ca/index.php/analysis-ontario-health-coalition-analysis-of-bill-60-your-health-act. Accessed 7 Dec. 2023.
About 30% of Canada’s health care is paid through a privately financed system. This includes services that are covered through private insurance (such as employee benefit plans) and those that you have to pay for out of your own wallet. This typically includes things like dental care, prescription drugs, counselling and other services not covered by OHIP.
The provinces are allowed to choose private providers to deliver care – as long as patients aren’t charged for services covered by OHIP.
SOURCE:
Understanding Public and Private Health Care. Canadian Medical Association, www.cma.ca/our-focus/public-and-private-health-care/understanding-public-and-private-health-care. Accessed 7 Dec. 2023.
In Ontario’s current health care system, OHIP pays for all medically necessary medical care services. With one payer, it ensures fairness. Treatment is delivered on the basis of need, not the ability to pay. It is equitable. All prices are centrally negotiated and there are no needs for extensive administration work or marketing.
With multi-payer systems, there is an additional layer of administrative costs. Insurance companies will need to develop benefit packages, explain them to potential customers, compete against other companies, evaluate applications for insurance, assess and pay claims. And in investor owned companies, they will need to turn a profit each year for the shareholders. We see this system with home, car and life insurance. It is expensive for the end-user and incredibly stressful.
SOURCE:
Martin, Danielle. Better Now: Six Big Ideas to Improve Health Care for All Canadians. Penguin, 2018.
According to Ontario’s Financial Accountability Office, the Ontario government has not been spending as much as they had budgeted in 2022-2023. They underspent by $1.7-billion.
In 2022-2023, the government had budgeted a spend of $194.29-billion. They only spent $187.1 billion. The current Ontario government has been spending less than budgeted over the last few years – including during the Covid-19 pandemic. In 2019-20, it spent $3.2-billion less than it had intended. In 2020-21, in the worst of the pandemic, it underspent by $8.6-billion.
This was not because the funds weren’t needed. The Ontario government chose not to spend all the money it had pledged to health care.
SOURCES:
Gray, Jeff. “Ontario Underspent Health Budget by $1.7-Billion in 2022-23, Watchdog Says.” The Globe and Mail, 3 Aug. 2023.
Briefing Note: The Ford Government’s Plan to Privatize Ontario’s Public Hospital Services, Ontario Health Coalition, Toronto, ON, 2023.
Casaletto , Lucas, and Cynthia Mulligan. Ford Government Allocating $21B Less to Fund Health Care, Hospital Capacity to Shrink: FAO. City News, 8 Mar. 2023.
Ontario Health Sector: 2023 Budget Spending Plan Review. Financial Accountability Office of Ontario (FAO), 31 May 2023, www.fao-on.org/en/Blog/Publications/health-update-2023. Accessed 7 Dec. 2023.
A report published by the College of Nurses of Ontario in June 2023 shows a trend that more nurses are choosing not to renew their annual licenses, take leaves of absents or move out of the province. People want to become nurses, but they are leaving the profession at an increasing rate.
A July 2023 report from the Registered Practical Nurses Association of Ontario (WeRPN), highlights why:
- 92% of nurses are expected to take on greater patient loads, despite not having enough time and resources to meet growing care needs.
- Patient care is being compromised. 91% of nurses have witnessed patient care be negatively impacted due to staffing issues. Among these nurses, 83 per cent are seeing increased wait times for patients, and 70 per cent have noted that it has gotten harder for patients to receive access to the necessary care they need, such as surgeries and diagnostics. An alarming 62 per cent of nurses say they’ve directly seen how delays in such assessments have resulted in a decline in patient health.
- 89% of nurses report that workplace conditions are causing them mental health distress.
Alarmingly, 62% of nurses are considering leaving nursing.
In 2023, the College of Nurses of Ontario made changes to their rules to help address the need for nurses. This has led to a substantial increase in the number of internationally educated nurses working in Ontario.