WESTERN STANDARD COLUMN: Alberta needs to try it the Lithuanian way on health-care

Where would you rather have a life-changing surgery: within your province or in a former communist country more than 7,500 km away?

Well, you might be surprised some people are making the decision to jet from Canada to eastern Europe for major surgeries. 

They can hardly be blamed. The Canadian health-care crisis has been getting steadily worse for decades.

Tens of thousands are dying while waiting for care. Wait times are the highest they’ve been since the Fraser Institute began tracking this problem thirty years ago. It’s very understandable some would choose to leave the country and pay for care elsewhere.

So why don’t provincial governments make it easier for patients to do so?

In the European Union, there’s a policy called the Cross-Border Directive. Patients who live in the EU have the right to travel to another EU country for surgery, pay for it and then be reimbursed by their home country. Reimbursements cover up to what it would have cost the government to provide the procedure done at home.

SecondStreet.org recently hired Leger to poll Canadians and see what they think of this policy. 

The results were overwhelming, with 74% of respondents being in favour of Canada copying this policy, while only 10% disagreed. This is up slightly from when SecondStreet.org polled Canadians on the same topic a year ago (72% in favour).

It’s easy to see how this European policy could help thousands of Canadians. Take, for example, the story of Len Granson, who lives on a farm not far from Rimbey, AB.

In a phone conversation with SecondStreet.org, Len shared how he was in need of a full right-hip replacement. He had been struggling with pain in his hip since 2021. It got to the point where he was crying himself to sleep many nights. His doctors prescribed him Percocet, a strong painkiller, but that came with the potential for serious long-term health problems, such as heart conditions.

He took the drug for about a year. Even so, the pain was so bad he could barely walk up stairs. Unsurprisingly, he had to take time off of his job as a power engineer at a gas plant.

After waiting two years, with no date for a surgery, he gave up on the Canadian system.

After searching online, he discovered the Nordbariatric surgical clinic in Lithuania. Len gave them a call and was able to book his surgery across the Atlantic within a month. He was impressed by the exemplary service. The surgery itself cost about $11,000, before travel costs. Everything went well, and he needed minimal after-care when he got home to Canada.

In a developed country such as Canada, there is no reason normal, working people such as Len should have to wait years for essential surgeries. However, the government-run system has been so inefficient for so long patients often only have two options: languish on waiting lists, or travel somewhere else.

The Cross-Border Directive would expand options to more patients such as Len. Travelling for surgery is not an ideal solution as many would prefer to be close to home and their families. However, this policy helps patients get their lives back and reduces suffering.

Patients such as Len could be allowed to expense surgical costs in other provinces or other developed nations. Suddenly they could have access to thousands of options and reduce wait times from ‘years’ to ‘weeks.’

This European policy also benefits people who don’t choose to travel for their care. Every time someone leaves the country for surgery, everyone behind them on the waiting list moves up a spot. 

It’s clear Canadians want this option. While Alberta Premier Danielle Smith has spoken favourably about this idea before, Alberta has yet to take any concrete steps to implementing it. 

If the premier does follow suit, more patients would receive the care they need in a timely manner. Isn’t that the point of the system?

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

This column was originally published in The Western Standard 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.