CALGARY HERALD COLUMN: Smith should pilot health reform idea instead of teasing it

Premier Danielle Smith continues to play footsie with a really good health-care policy idea in place throughout the European Union. It could particularly help low- and middle-income patients in Alberta and it polls well, to boot.

Instead of musing about it, the premier would be wise to try it out as a pilot project.

At a recent conference in Red Deer, Smith again raised the possibility of the government reimbursing patients when they pay for medically necessary surgeries abroad. Patients would have this option when facing local wait times that are longer than recommended, and reimbursements would cover up to the same amount the Alberta government would spend locally. Smith ran on this idea back in 2012 when she was Wildrose leader and also raised the policy last year on her radio show.

It’s easy to see how this policy could immediately help many patients. Instead of spending a year of your life in pain, off work and waiting for surgery in Alberta, you could potentially go to the U.S., Europe or some other developed nation and receive surgery in a couple of weeks. 

The European Union passed a similar policy in 2011. It’s called the Cross Border Directive and it gives EU patients hundreds of additional options for treatment if local wait times are long for a particular type of surgery. To be clear, just as Smith has suggested for Alberta, this is an option for European patients — no one is forced to travel for treatment.

Polling conducted by Leger for SecondStreet.org in late 2023 found that 68 per cent of Albertans like the idea of their government implementing this policy.

It’s easy to see why so many people would like it. Health care is in crisis across Canada. Many patients are desperate. Wealthy Canadians have the funds to go abroad if they want to avoid long wait times, but low- and middle-income patients are often left behind. This policy would give all patients an option to escape long wait times.

So, what’s the holdup?

Earlier this year, Smith asserted that the cost of such a program could be high. She is absolutely right to want to be cautious with the province’s finances.

But this policy doesn’t really cost more money. If Alberta Health provides patient John Doe with surgery in six months at a cost of, say $15,000, then it doesn’t cost more if Alberta Health reimburses him next week for the same amount after he receives surgery in the U.S., Europe or some other location with reputable health care.

Smith has noted that her government is pursuing a number of health reform measures and wants to give them a chance before implementing a reimbursement policy. We should all hope that her reforms are successful, but reform takes time and countless patients are suffering right now. Reimbursing patients for care abroad is an accountability measure, one that recognizes that the government has taken their money, but hasn’t provided care in an ethical time frame.

The Alberta government doesn’t have to jump into this policy head first. It could try out a pilot project just for patients requiring knee surgery, cataract surgery or some other type of surgery that has long wait times

To be sure, this concept is imperfect. Without a doubt, it’s more convenient for patients to receive surgery in their hometown.

But what this policy does is give patients another option — wait in Alberta for surgery, or travel and get treatment sooner. For many, it will be a lifeline to escape the chronic pain, loss of income and other struggles they face right now

If Smith tries out such a project, she’ll likely find a lot of happy patients while creating a more accountable health-care system.

Colin Craig is the president of SecondStreet.org, a Canadian think-tank.

This column was originally published in The Calgary Herald on October 11, 2024.

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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.