WINNIPEG FREE PRESS COLUMN: EU Health Policy Could Ease Manitoba’s Wait Lists

Canada Healthcare SecondStreet.org

Know someone who is suffering on a long health care waiting list? A health-care policy that’s used across Europe could help reduce waiting lists in Manitoba immediately.

All it would take is a bit of vision.

The policy in question is known as the “cross border directive,” and it applies to all European Union (EU) countries. What it does is allow a patient in an EU country to travel to another EU country for surgery, pay for it, and then be reimbursed by their home country.

Reimbursements are provided for up to what the home country would have spent to provide the surgery for the patient locally. This policy allows EU patients to avoid long waiting lists by choosing from countless public and private health facilities across Europe.

In Manitoba, and the rest of the country for that matter, patients have far fewer choices when it comes to health care. While European patients can choose between universal health-care services and private options, Canadian patients are forced to rely on government health services or to travel outside the province and pay the full bill.

Copying the EU’s reimbursement concept could allow a Manitoban on a waiting list to instead duck across the border to North Dakota or Minnesota for surgery. Perhaps a Manitoban from Lithuania could schedule their surgery while they’re visiting relatives in Europe this summer.

A snowbird might book their hip surgery in Arizona instead of waiting another year or two in Manitoba. One can think of many different possibilities.

In each of the aforementioned cases, it wouldn’t just be the travelling patients who benefit. Those who remained on government waiting lists would get to move up a spot in line each time a patient ahead of them decided to travel to another country or province for surgery.

Thankfully for the government, this option doesn’t really increase costs over the medium term – it merely means paying for a patient’s surgery sooner rather than a year or two down the road. In fact, it could even save money when one considers that long waiting periods often lead to costly health complications.

Astute observers would note that provincial governments in Canada, including Manitoba, will already cover the cost of some planned surgeries abroad. However, “some” is the key word. While this option is rare in Canada, in the EU, most reimbursement requests are approved – 84 per cent in 2019.

Make no mistake, this policy option is not without shortcomings. Travelling abroad for surgery is often inconvenient and in Europe, patients have to cover their travel costs. But one can’t ignore the fact health care in Canada is in a crisis situation. This policy could help.

Far too many Canadian patients are being forced to wait a year or two for surgery. Far too many people deal with chronic pain and suffer damage to other organs after popping painkillers over long periods of time. Some patients even develop depression during their long waits for surgery.

Data from SecondStreet.org shows that in excess of 11,500 Canadian patients died in 2020-21 while waiting for surgery. A majority of the cases appear to be for non-life-saving surgeries such as cataract procedures and hip operations, but would you want to spend your final days wandering around with cloudy vision or stuck in your apartment with chronic joint pain?

The data obtained by SecondStreet.org also showed cases in which patients died while waiting for surgeries that could have potentially saved their lives.

Without a doubt, special-interest groups will reject this idea. But special-interest groups always reject ideas that don’t involve simply throwing more money at the health-care system and hoping it works. Governments have tried that approach for decades, and we’re still talking about the same problems.

Copying the EU’s cross border directive could ease the pain of a lot of patients. Isn’t that the point of the health-care system?

Colin Craig is the president of SecondStreet.org.

This column was published by the Winnipeg Free Press on August 2, 2022.

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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.