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TRUE NORTH COLUMN: It’s time to think across borders on health reform

Imagine if provincial governments could immediately reduce long health care wait times for thousands of patients from “years” to “weeks.” Canada could do just that if we copied a policy from the European Union called the Cross-Border Directive.

In the European Union, patients have the right to travel to another EU country for surgery, pay for it, and then be reimbursed by their government. Reimbursements cover up to the same amount it would have cost their government to provide the procedure locally.

It’s true that provincial governments sometimes reimburse patients for surgery in other jurisdictions – but that’s not the norm. Such cases tend to involve treating very rare diseases rather than common problems such as hip and knee replacements. 

Take, for instance, Sharon Kilkenny. The Saskatchewan woman faced a 93-week wait for hip replacement surgery. She couldn’t put up with the pain and mobility loss for that long, so she traveled to Alberta and paid for private surgery.

After she had her surgery in April of 2022, she decided to see if she could receive reimbursement from the provincial government. She told SecondStreet.org that, after eight months, she was denied.

If provincial governments had the same policy as the E.U.’s Cross-Border Directive, it would have made Sharon’s life a lot easier – and the lives of thousands of other patients, who don’t have the means to scrape together enough money to travel for care.

Research shows Canadians love the idea of bringing this E.U. policy to Canada.

SecondStreet.org recently hired Leger to poll Canadians on what they think about the idea of copying the EU’s Cross-Border Directive. The results were conclusive. A staggering 74 per cent of respondents are in favour of implementing the policy in Canada. Support was high across all age groups, coast-to-coast, and among both men and women. 

And why shouldn’t it be?

It’s easy to see why people waiting for surgery like the idea. It provides an option for them to get care more quickly. Simple. However, even if someone decides not to travel for surgery, the policy helps them, as well. Every time someone leaves the country to get care, everyone behind them on the waitlist moves up a spot. This could be a simple way to, for many patients, reduce wait times from years to weeks. 

It’s also important to note that this policy could be cost-neutral in the medium term. Since we have a universal health care system, these are all surgeries the government would be paying for anyway. Allowing patients to travel merely shifts when the expense happens – now, instead of next year.

There may need to be some moving around of money in the government’s budget, but it’s really not a significant cost in the long term. Considering how governments at all levels in Canada are willing to throw away money on things like an $8 million barn, or spending $2 million to keep a failing coffee shop open, it shouldn’t be too much of an ask to pay for medically necessary surgeries earlier.

The Canadian health care system is not running as it should. Tens of thousands are dying while waiting for care, doctors and nurses are leaving to the U.S. and average wait times keep climbing.

The status quo in health care can not keep going as is. It’s time for governments to take bold, new directions on health care reform. While copying the Cross-Border Directive isn’t a silver bullet that will fix all of our problems, it’s a start. It would be relatively easy to implement, it could immediately lead to a drop in wait times, and Canadians clearly want to see it happen.

So what’s the hold-up?

Dom Lucyk is the Communications Director with SecondStreet.org, a Canadian think tank.

This column was originally published in True North on November 11, 2023.

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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.