Krishnaraj: And How Will You Be Paying for Your Baby Today? [birth tourism]

Good in person account of how birth tourism and other medical services affects doctors and the healthcare system:

…The primary intended use for the credit card terminal was to collect fees from uninsured, non-resident patients. These patients, who are not covered by provincial, federal, or private insurance, need to pay out of pocket for services provided in the hospital. If they are admitted, the hospital cashier collects fees for services like the bed, food, medication, and nursing care. But doctors must collect their fees directly from these patients. The amount that they bill for each specific service is guided by a document of standardized fees published by the Ontario Medical Association.

If doctors don’t bill and work in a fee-for-service system, they do not get paid for their work. Which is why in the doctors’ lounge at Humber Regional Hospital, the question was not how much to bill, but rather how to have these conversations, and when.

Is it on admission, hoping for no complications, and no further charges? Prior to letting the non-birthing parent into the operating room during a caesarian? Or do you ask the new mother to reach for their wallet as the baby is learning to nurse?

Turns out there’s no good time to give someone a bill for their baby.

This is a side of practising medicine in Canada that is rarely discussed. There were an estimated 5,430 non-resident births in Canada in 2024, according to analysis of Canadian Institute of Health Information data published by Policy Options. This is just below the historic peak of 5,698 in 2019. In 2023 — the year I was at Humber —the hospital had the highest rate of non-resident births in the country, accounting for roughly one in 10 deliveries.

I witnessed this firsthand. Almost every day, I would be asked to assess the newborn baby of an uninsured, non-resident mother on the postpartum ward….

Gautham Krishnaraj MDc PhD is a Fellow in Journalism & Health Impact at the University of Toronto’s Dalla Lana School of Public Health. 

Source: And How Will You Be Paying for Your Baby Today?