PART III: Cross-Border Care

MELINDA DALTON, JOE FANTAUZZI and MATTHEW STRADER

November 29, 2009

Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home.
A Metroland Special Report shows thousands of others  are funding their own medical treatments south of the border,  at high personal cost.
The numbers have been rising for the last 10 years. Government approvals for out-of-country health care funding are up 450 per cent.
Should Ontarians have to use a passport to get health care? 

---

Many Ontarians know the personal health-care stories of Shona Holmes, Lindsay McCreith and Belinda Stronach, the former federal cabinet minister and Magna International auto heiress.
The three are among the public faces in the emerging debate over growing numbers from Ontario going to the U.S. for medical care.
Many, such as Stronach, who went to California for some of her 2007 breast cancer treatment, pay U.S. medical bills entirely on their own.
Others, such as Holmes, of Hamilton, and McCreith, from Newmarket, elect to go south for what they believe is their only option, then battle with the Ontario government to be paid back.
Figures published in Metroland’s Special Report on Cross-Border Care show Ontario patients are travelling to America for health care in record numbers.
 Ontario expects to spend an estimated $164 million next year on cross-border care, triple the $56.3 million spent in 2005.
 There’s been a 450-per-cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a time of explosive growth in new technologies and therapies not covered or available here. Ontario funded 2,110 out-of-country procedures in 2001, and 11,775 last year.
“Those astounding figures … don’t include the people who don’t actually get OHIP pre-approval,” says NDP leader Andrea Horwath.
“They just skip that whole process because they have deep pockets and they can pay to get the procedures in a private system down in the States. And that further erodes the public system here.” 
Long waits for MRIs and other diagnostics, poor access to doctors and unacceptable delays for some surgeries are worrisome, says the 2009 report of the Ontario Health Quality Council, set up by the province to monitor the state of health care.
There’s been some progress, the council says, but the Ontario health system is not meeting all needs.
“People should be able to get the right care at the right time in the right setting from the right provider,” the report says.
 McCreith and Holmes believe their rights to care were breached.
Last month, McCreith lost his appeal to have OHIP repay the $27,600 US he spent in Buffalo in 2006 on brain cancer surgery. McCreith says he would have had to wait four months for an MRI, and three months more to see a specialist if he had not gone south.
 Holmes — who spent $95,000 on brain surgery at the Mayo Clinic in Arizona — became a darling of the U.S. conservative movement when she agreed to be the face of American TV ads against President Barack Obama’s health-care plan last spring.
Holmes’s comments that Canadian-style health care failed her set off a firestorm north of the border.
 That’s partly because crossing the border to get U.S. health care has for decades been regarded as taboo. But as waiting lists swelled, and access began to lag, out-of-country travel for medical care became more common, Ontario figures show.
Natalie Mehra, a director of the Ontario Health Coalition, a public interest health care group, says she hopes the government’s response will be to rebuild access to hospital services in the public system here.
 If the growth in out-of-country care continues, “I fear it will simply serve as fodder for the American media and the privateers in Canada,” Mehra said.
She was referring to the ongoing debate in the U.S. over how to provide health care, in which Shona Holmes figured, and companies pushing for the right to offer Ontarians health care in a pay-for-service, private parallel system.
“That (private health care) would be not a solution at all, but in fact the dismantling of our public health care system.”
Nationwide opinion polls consistently show high levels of overall satisfaction with Canada’s universal health care. Still, researchers are also finding disquiet over some of the system’s vulnerable areas.
More than 50 per cent of respondents cited concerns about wait times for treatment, a shortage of medical professionals or lack of government resources, according to a Nanos Research poll released this month.
Critics say Ontario should fix the system here, and use the out-of-country approvals system exclusively for the reason it was set up — to be a “safety net, allowing access to new, proven procedures, and help fill gaps in provincial medical services,” says a 2007 review of OHIP’s out-of-country procedures.