|
 |
|
|
|
Health Care - The Health Care Exodus: Canadians heading east for medical care |
|
|
|
Written On: May/June 2007 |
|
|
|
Written By: by Danielle R. Rhéaume |
|
|
|
Anyone who has endured chronic illness or sustained a painful injury knows that time spent awaiting treatment is time spent suffering. That’s why many frustrated Canadian citizens on lengthy medical waiting lists seek health care outside Canada’s borders. In the past, many traveled to the United States. Now, with the affordable and progressive medical treatment becoming available in developing nations, many are electing to pay out-of-pocket and fly across the world for care that they’re simply not willing to wait for.
In most advanced countries, two tiers of health care are available. The first tier, which Canadians refer to as Medicare (no relation to U.S. Medicare), is publicly funded for citizens. The second tier is for citizens who can afford to pay for private, and often better, care. Canada, with the exception Quebec, does not provide the latter option to its citizens. Surprisingly,
it’s illegal for Canadian citizens to pay out-of-pocket for private health care that the public system provides.
"The Canadian model is not a model to look up to," said Nadeem Esmail, director of health system performance studies at the Fraser Institute in Vancouver, British Columbia. "Rather than being a two-tier system, it’s a four-tier system," he said.
According to Esmail, occupying the first and most advantageous tier are those who are wealthy enough to leave the country for medical care. According to the Fraser Institute, more than 39,000 people fell into this category last year.
In the second tier are RCMP officers, people on workers’ compensation, and prisoners. Yes, prisoners. People in this position are offered express medical care at the few private clinics that operate in Canada for the sole purpose of treating this class of patients.
"Then, in the third tier," Esmail said, "you have the people who are connected." These people may know a doctor or someone important who can move them up on the waiting list for public care. Indeed, nepotism rules, even in Canada’s public health system.
Filling out the fourth tier is the rest of the population—people who languish on waiting lists for months, sometimes even years.
One political cartoonist characterized this grueling wait by drawing a doctor approaching a skeleton with a tongue depressor. While the skeleton wears a Medicare sign around its neck, the doctor orders him to "Say ahhhh!"
Another cartoon shows two elderly women behind bars. One woman asks the other woman, "What are you in for?" The other woman tells her "hip replacement." In the Canadian system, a convicted criminal would get hip replacement surgery before you or your grandmother.
In a 2006 bulletin titled "Waiting Your Turn," the Fraser Institute reported that British Columbians wait an average of 52 weeks for hip and knee replacement surgeries, 36 weeks for orthopedic surgeries and 8.5 weeks for cardiac surgeries. In that time, according to Esmail, some people become addicted to pain killers, resulting in liver damage that prevents them from having the surgery they’ve been waiting for.
Esmail described these conditions as "inhumane."
According to the same bulletin, waiting for treatment not only affects people physically, but psychologically and financially, as well. The institute explains:
"Monetary and non-monetary costs are nevertheless born by Canadians, even though these costs are not explicitly recognized. These unrecognized costs may include, for example, lost work time, decreased productivity associated with physical impairment and anxiety, and physical and psychological pain and suffering ... a working person incapacitated by illness bears the costs of the loss of work. These costs are not associated with the running of the health care system."
"It’s like somebody’s telling you that you can buy this car, and you’ve paid for the car, but you can’t have it right now," as one Canadian put it. "Every day we’re paying for health care, yet when we go to access it, it’s just not there."
As a citizen of both Canada and the United States, I’ve heard many opinions about Canadian health care, though none as delusional as the one that imagines Canada as a healing paradise for the ill. Many of my acquaintances have bemoaned the medical system in the United States, stating that it should be "free—like in Canada." What they don’t realize is that Canadian health care isn’t free. Canadians pay very high taxes for their health care system (the average two parent, two child household pays nearly $10,000 in health care taxes per year), only to wait insufferable amounts of time for care.
In the past, Canadian "medical refugees" often came to the United States to escape waiting lists and to receive immediate—albeit more expensive—medical care. Now, many of them are heading overseas for first-class health care at third-world prices.
How can they resist when medical tourism companies, like India’s Apollo Hospital Enterprises, have stepped in to meet patients’ needs with all-inclusive medical retreat packages that, according to their mission statement, "Bring health care of international standards within the reach of every individual?"
Medical care in India is often only a tenth and sometimes even a sixteenth of the price in the West, according to Medical Tourism Canada. For example, an open-heart surgery that could cost up to $150,000 in the United States may cost just $10,000 in one of India’s finest hospitals. As an added bonus, these numbers often include airline fares, transfers, hotels, treatments and a post-operative vacation in a five-star hotel. Concerned about the quality of care? Not to worry—the facilities have hospital accreditation from the United States and are staffed by U.S.-certified surgeons.
Many uninsured Americans are now catching on to the trend. Not only can they save staggering amounts of money by seeking care overseas, but they can also get cutting-edge surgeries like hip resurfacing, which has already been established in Europe and Asia, but has not yet received FDA approval in the United States.
American employers who suffer from steep health care liabilities and governments that impose more costs are also beginning to see the benefits of medical tourism. According to the Pacific Research Institute in San Francisco, "In some cases, an employer may actually save money by covering the operation, travel and accommodation expenses for an employee and a spouse going abroad for treatment."
One North Carolina employer recently offered an employee $10,000—a portion of what they expected to save—as an incentive to have shoulder and gall bladder surgeries overseas. The patient accepted their offer, but then his union stepped in to halt their plans by raising the issue of medical liability. Who would pay if something went wrong? It’s difficult to hold a foreign surgeon accountable for malpractice when the U.S. government cannot legally intervene in foreign medical practice.
Nevertheless, globalization is knocking on the door of health care in the West and many people who are frustrated by domestic health care costs and waiting lists are answering. At this stage, it is hard to say whether the trend will slow down or accelerate—it depends largely on what the Canadian and U.S. governments decide to do locally.
In June 2005, two justices shook the high court in Quebec by announcing, "Access to a waiting list is not access to health care." In response, Premier Jean Charest announced that the private sector could play a role in Quebec’s health care system. He also initiated a provincial movement to set maximum wait times for some essential surgeries. In 2006, the federal government of Canada responded by working towards establishing nationwide patient wait-time standards.
Sally Pipes, head of Pacific Research and a Canadian expatriate, said that she’s skeptical of the changes. "It won’t make a difference. They need to break the system down, or open the system up to competition." Until then, Canadians may continue to seek care from afar.
|
|
|
|
