SASKATOON STAR PHOENIX COLUMN: Import EU Cross-Border Health Care to Reduce Sask. Surgical Waits

dom EU health column screencap

Imagine living with cloudy vision, not being able to see at night and being blinded by bright lights. Those are common symptoms for people struggling with cataracts.

While wait times for cataract surgery and many other surgeries in Saskatchewan are currently quite long, there’s a policy solution from Europe that could help patients receive the surgery they need much faster.

As of April, there were approximately 4,500 people in our province waiting to receive cataract surgery alone. If you add in all other surgeries, the total number of patients waiting for surgery rises to more than 35,000  — that’s more than the capacity of Mosaic Stadium. It’s not just Saskatchewan; across Canada, governments postponed thousands of surgeries during the pandemic, making our nation’s waiting list crisis even worse.

Patients in the European Union, however, have more options when confronted with long waiting lists, including something called the “cross border directive.”

This European Union policy allows a patient in one EU country to travel to another EU country for surgery, pay for it and then be reimbursed by their home country. Reimbursements cover up to the amount the home country would have spent for the procedure locally.

It’s easy to see how this could have an immediate positive impact for Saskatchewan patients.

Patients facing long waits for cataract surgery could travel just over the border to the United States and receive surgery quickly instead of having to wait half a year, a year, or more. For instance, the Dakota Eye Institute in North Dakota informed SecondStreet.org that its waiting list is usually only two weeks or so. Bill Marion, the manager of the company, noted they would be happy to have a bus load of patients come from Canada for surgery.

One shouldn’t chuckle at the idea of a busload full of Saskatchewan patients heading abroad for timely surgery. Beginning in 2017, two politicians from Ireland regularly organized busloads of patients to travel to the UK for cataract surgery. As of 2019, they had helped around 1,500 patients receive faster cataract surgery  — and reimbursement from the Irish government.

Of course, the Saskatchewan government could allow reimbursements for more than just cataract surgeries abroad. One Manitoba patient calculated that his successful knee surgery in Lithuania actually cost far less than what the government would have spent at a public hospital in Winnipeg.

Needless to say, there are cases where surgery abroad may cost patients more than what the government reimburses. Thus, it’s up to patients to decide if they want to pay the difference or wait for the government to provide surgery. Like it is in Europe, this policy would be completely voluntary.

In fact, it would even help those who remain on government waiting lists in Saskatchewan. Every time a patient travels abroad for surgery, they leave the waitlist and everyone behind them moves up a spot.

It’s important to note that government expenses for this policy would be minimal over the medium term. Instead of paying, say, $7,000 for John Doe to receive cataract surgery in Saskatchewan next year, the government would spend $7,000 to reimburse John Doe for his surgery abroad this year. Not only does John’s life improve sooner, reducing patient wait times can often save the patient from other health complications — and save the government from paying for them.

The Moe government has set a goal of reducing waitlists back to pre-pandemic levels by 2025. Importing this policy from the EU would allow for a significant step toward that goal.

This policy is a win-win. It’s essentially cost neutral to the government, would reduce the stress on the health-care system and, most importantly, it would let people get the care they need more quickly.

Dom Lucyk is the communications director with SecondStreet.org, a public policy think tank.

This column was published by the Saskatoon Star Phoenix and the Regina Leader-Post on August 17, 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.