Health care beyond our border

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This past December, Kris Sims from the Canadian Taxpayers Federation and I drove from Burnaby, B.C. just over the border to a hospital complex in Bellingham (Washington State).

We were hoping to talk to Canadians about why they were leaving the country for health care.

As you can see in the clip above, Kris was particularly interested in the value for money aspect of Canadians leaving the country for health care. After all, Canadians pay high taxes and many pundits claim that’s because of our universal health care system. If someone is leaving the country for health care, there’s a good chance they’re probably not too satisfied with the service they’re receiving for the money they’re paying.

SecondStreet.org’s interest in the trip was more related to the economic aspect of medical tourism. After all, every time someone leaves Canada for health care they’re not only spending money on things like the cost of the health procedure in another country, there are usually other expenditures abroad, such as food, transportation costs, accommodations, etc.

In short, Canada is missing out on economic opportunities when patients leave the country for health care. (Not that we’re blaming people for trying to improve their health.)

While we found lots of examples of vehicles with B.C. license plates parked in the middle of the Bellingham health care complex, we unfortunately did not find any Canadians near their cars.

We did however, speak with a staff person at one of the private clinics located in the health campus that was willing to talk with us. Reanna Furnari, an administrator with Pacific Northwest Urology Specialists, was kind enough to take a few minutes of her time to discuss their practice and her observations working in health care.

Clinic Pic

Notably, Kris asked Reanna about Canadians visiting the U.S. for health care. Here’s their exchange:

Kris: “Speaking generally, do you hear that there are Canadians coming down to the Bellingham area to seek health care and to seek specialized care?”

Reanna: “I think it’s been that way for a long time and I think it’s on the rise. I think access to health care in Whatcom County versus up in Canada is often times more timely from what I understand. And then of course we have a lot of specialties that you’re able to get into probably faster than you would up there.”

Between Reanna’s comments and the dozen or so license plates we saw at the health care complex, it’s easy to see how Canadian patients made over 217,500 trips abroad for health care in 2017.

Colin Craig is the President of SecondStreet.org

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.