WESTERN STANDARD COLUMN: Patients are tired of being patient

Canadian health care is in crisis. This isn’t new information. For years, thousands have died on waitlists, while governments have thrown money at the system and wait times have steadily grown.

It’s time for action, now. 

Canadian patients should not be forced to sit and suffer on waitlists with no other option. Thankfully, Europe has a policy in place that our country could copy and help more patients receive treatment within weeks rather than years..

First, a little history.

In 2002, the United Kingdom (UK) was still a part of the European Union. Yvonne Watts, a 71-year-old English woman, was suffering from arthritis in her hips. She needed surgery, but the government system in that country told her she would have to wait a full year.

In Canada, waiting a year might actually seem like a decent deal (considering the average wait time for a hip replacement in Edmonton is around 15 months, with some waiting well over two years.) But for Watts, it was unacceptable. She travelled to France and got her surgery, paying the equivalent of over $10,000 CAD (adjusted for inflation). When she came home, she argued she should be reimbursed for the cost, but was refused by the government.

Unfortunately, she never did receive payment for her treatment, but she paved a path that would go on to make health care better across the EU much later.

A European Union court judge ruled that governments in the EU should have to reimburse patients for their care abroad. Her case was used to justify the Cross-Border Directive, an EU policy introduced in 2011. In short, it allows patients in one EU country to travel to another, pay for surgery, then be reimbursed for up to the amount it would have cost their home government had the surgery been done locally.

This just makes sense. In a universal system, governments charge citizens taxes (in Canada’s case, extremely high taxes) and promise a functioning health care system. But if the government can’t deliver, it’s completely reasonable to expect they would make it easier for a patient to get care elsewhere. 

It’s also something that could be implemented quickly and with minimal cost. Since patients would have received care in Alberta’s government-run system at some point, reimbursing them for care abroad wouldn’t bring extra costs — it would just mean the cost for the surgery would come earlier. 

So, what’s the hold-up? Alberta has its fair share of cases like Watts’… and far worse. 

There are perhaps no better examples than Jeff Krushell. He lives close to Edmonton, and suffered from chronic, severe back pain due to a spinal problem. He’s usually a friendly, likeable guy, the type of guy you’d love to grab a beer with and watch the Oilers game.

But it’s genuinely heartbreaking to hear him talk about life before his surgery.

“This pain… it engulfs you. It takes over. And I’m a pretty upbeat, happy person, but it sucks the life (out) of you. I slipped into a very, very dark place. I have a real appreciation for depression now, and the darkness that revolves around that … I can’t even tell you the emptiness, the helplessness, that not just me, my family was going through at that time,” he said.

And with all that suffering, he was told he would have to wait over a year for corrective surgery in Alberta. Unable to cope with the pain, he took matters into his own hands and flew to the U.S. for care.

If the Cross Border Directive had been in place in Alberta, Jeff could have had at least some financial assistance to help pay for his surgery abroad. Considering he paid into the system for his whole life, and it wasn’t there for him, a reimbursement would have at least been something.

Sadly, this is not a one-off. Until Alberta seriously reforms its health care system, patients like Jeff will continue to suffer. 

In Europe, they took this as a lesson and came up with the Cross-Border Directive, which has improved the lives of many patients and made their system better.

Alberta should do the same.

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

This column was originally published in The Western Standard on October 24, 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.