SUN NEWS COLUMN: An opportunity for patients and our economy

Several years ago, Ken, a contact from Winnipeg, told me about the time he drove down to the United States for an MRI scan.

Ken was an active person back then. He liked to play racquetball, had young children and was involved in his community. But he had developed shoulder problems and was told by the government that he would have to wait a year for an MRI just to assess his problem.

As the Manitoba government had essentially blocked private clinics from being able to offer MRI scans to the public, Ken’s choice was clear – wait a year on the sidelines or travel to another country and pay for an MRI.

The economic angle to stories like Ken’s has always struck me – what if Canadian governments continued to fund the public system, but allowed patients the option of spending their own money on health care in Canada? How many jobs could be created if those dollars stayed in Canada? How many tax dollars would those workers and businesses pay? (Tax dollars that could then be used to help pay for our public system.)

Our new think tank, SecondStreet.org, decided to look more closely into this issue.

Ken wasn’t someone you would describe as “rich.” But he was able to pull together $800 (Canadian) for an MRI scan at a reputable clinic in Minnesota; and he was able to get the procedure within a few days of calling the clinic. In addition to the fee for the MRI, Ken spent money on fuel, food and accommodations in the United States. If memory serves me correctly, I believe he also did some Christmas shopping while he was away.

Data from Statistics Canada shows that Ken’s story is far from unique. In 2017, Canadian patients made at least 217,500 trips to other countries specifically for “health and medical reasons.” To put that in perspective, that’s more than the population of Kelowna, B.C. or Barrie, Ontario. If you imagine a sold-out NHL game in Canada, you can multiply that crowd by at least ten.

But the 217,500 figure is only half the story. In most cases, patients don’t travel alone – friends or relatives will accompany them. If you include those travelling with Canadian patients, the total rises to over 369,700 people on the low end and over half a million people on the high end.

In dollar terms, Canadians spent an average of $1.9 million every single day in 2017 on health care in other countries. This figure includes emergency health expenses and cosmetic procedures but it’s still a striking number nonetheless.

If politicians want to keep some of these dollars in Canada, and perhaps position our country as a medical tourism destination, the solution is straightforward. Governments could continue to fund our public health care system, but give you the right to pay out of pocket for health care at a private clinic if you so desired.

That is what Australia, New Zealand, the United Kingdom, Sweden and many other countries do. The progressive-leaning Commonwealth Fund ranks these countries’ health care systems as far more effective than Canada’s system.

Giving patients more private options won’t solve all our system’s woes. Such a move would, however, provide patients like Ken with more choice, reduce stress on our struggling system and even give our economy a bit of a boost.

 

Colin Craig is the President of SecondStreet.org, a new Canadian think tank.

This column ran in Sun newspapers on March 23, 2019.

Share on Facebook
Share on Twitter

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.