Canada is an important and growing market for medical travel.  Current estimates for Canadians finding private care for medically necessary procedures are approaching 100,000 annually.  Statistics indicate that this trend is growing steadily.  The backdrop for this trend is to be found in understanding the Canadian healthcare system and the unique culture of health that exists in this country.  As a Canadian and a medical facilitator in Canada, I am pleased to share my knowledge and experience.

The debate on public versus private health care in Canada is not new but it has never been so important.  And while many think they understand our dilemma many have been misinformed.  All you have to do is watch the documentary film, Sicko by Michael Moore to realize that the Canadian health care system is terribly misunderstood and sensationalized to adapt to political needs opposed to humanitarian ones.

Privately delivered health care is already part of healthcare in Canada.  Surprised?  When a Canadian patient walks into their family practitioners office, the clinic in itself is privately owned and operates on a for-profit basis and thus, the services rendered are privately delivered.  The same holds true for a local non-hospital lab or radiology centre.  Most of the services delivered however are publically funded i.e. covered by Medicare but additional ‘non-essential’ services are not.

In contrast, hospitals are government run entities and their services are publically delivered on a not-for-profit basis.  Currently, Canadians have the option to buy supplementary insurance to cover these non essential services which includes ambulance services, private beds and numerous other services such as cosmetic surgery and massage therapy that are not considered essential.

To further clarify, if a patient walks into their family practitioners office a physical exam will be covered but if they wish to further their care with a vasectomy, they will be billed for the procedure because it is not a covered procedure.  Fee schedules for each procedure are set by the government not the hospital or clinic. Each hospital has their own board and those boards are held accountable to the Regional Health Boards which are part of the government.   The Hospital Boards and Regional Health Boards spend considerable time pleading with the government for more money to provide the care that is needed.  An example of the cost versus care imbalance is that the charge for an amniocentesis (invasive test of a pregnant woman) is typically less than what many women pay to get their hair cut. 

Within the publically funded Canadian system, patients often experience long waiting times even for essential services such as emergency room visits, hip & knee replacements and even cancer treatment.  In the spring of 2009 the Canadian Press reported that Ontario cancer patients are still waiting twice as long as recommended for urgent and potentially life-saving surgery. This is especially alarming considering the combination of aging baby boomers and the fact that people are living longer with cancer.  It is anticipated that the number of Ontarians with cancer will jump from 275,000 to more than 400,000 by 2017 (Windsor Star, May 2008).  This has been referred to as a crisis on the horizon.

 In 2008 the Fraser Institute reported an estimated 750,794 Canadians were waiting for care after an appointment with a specialist.  Orthopedic surgery yields an especially long waiting list.  There were 92,626 procedures for which Canadians were waiting for after an appointment with a specialist in 2008.  The large majority of these patients are our baby boomers.  And for the boomers that are in their 40’s and 50’s it is not uncommon for them to find themselves as the care manager for their aging parent who is also in need of a similar surgery.  It is this waiting time, which can extend to years, yes years, which proves to be the detriment to sustainability of the patients quality of life.  Unfortunately, when referring to excessive wait times, most often excessive, is used to describe economic suffering.  The focus needs to shift to the significant costs reflecting the exhausting physical and emotional toll that waiting for treatment takes on the patients and their loved ones.

The Canadian Medical Association estimates that between four and five million Canadians are without a family practitioner.  In most provinces no more than 15% of doctors are taking new patients.  The Ontario Health Quality Council indicates that Ontario is producing more doctors than ever before, but access to family doctors has not improved since 2006.  About 7.4 percent of adults don’t have a family doctor, and half of that group, about 400,000, are actively looking for a doctor but can’t find one.

With respect to physicians in Canada, they are self-employed yet only paid by the government.  They negotiate their compensation much like a union dues, thus their earnings have a ceiling.  Many of the waiting list woes have been created by physicians refusing to work beyond what their salary allows.  To avoid working for free, they simply manage their billable hours to accurately reflect their negotiated earnings.  This, obviously, has added to Canada’s waiting list problems yet the population of patients, on a whole, has a sense of understanding and compassion for the doctors despite the suffering that it may cause personally.

Canada has just two thirds as many doctors per 1,000 population as the OECD average. Canada’s current population stands at just over 33 million.  We would need 26,000 additional doctors just to bring ourselves up to the norm for industrialized countries.  And the situation is likely to get worse before it gets better.  The average Canadian physician is 50 years old.  Due to retirement and population growth, an additional four or five million Canadians will be without a regular doctor by 2018, the CMA estimates.  At any given social gathering, it is now common place to discover that at least one person in the room is suffering from the emotional and physical distress that inaccessibility to health care provokes.

Canadians have been socialized to be all accepting and never questioning of our health care system.  Paying for health care procedures can immediately manifest feelings of betrayal or disbelief just as placing trust in a ‘foreign’ doctor can feel treasonous.  This is the emotional junction that either becomes the prison or the catalyst when it comes to care.  To understand the opportunity one must also understand the culture, the history and the system.  Our baby boomers have been raised to have the solitary experience of submitting their health care card in exchange for all of their medical services.  Words related to cost were never spoken.  “Choice” was also omitted from our health care vocabulary. My intimate knowledge of the Canadian culture and the ability to respond to the unique needs that each Canadian patient represents has proven invaluable.  Extensive research and hands-on experiences continues to illustrate that Canadians are timid and generally acultured to taking very little responsibility for their health care…even when their lives are at stake.  We do what the doctor says, or in this era, we wait to see what the doctor will say and pray time doesn’t prove deadly.

Obtaining health care outside of Canada is a choice.  For some it is a blessing.  For everyone it is an education.  Trust is the most critical component in such an undertaking.  Quickly we are learning that heading south for care isn’t just for the affluent.  It is for anyone willing and capable of shifting from the wait list to the VIP (very important patient) list. We also understand that state-of-the-art medical facilities do exist without out-of-this-world price tags for procedures.  The number of Canadian medical travelers is growing.  With positive experiences to share with friends and family, we can expect this trend to continue.

Kelly Meloche brings her years of experience as a Tactical Communications Instructor for the Province of Ontario as well as her credentials as a Sports Performance & Chronic Pain Specialist forward to help Canadians find the solutions to their health care needs.

As President of International Health Care Providers Inc, Kelly provides seamless facilitation of Canadian patients to her network of superior international health care partners.

Tags: Canadian Healthcare, International Healthcare