Canadian relatives and friends: I am worried about you

[roster]

When we get our new socialized medicine and fall to your level, where will you go for excellent treatment?

Cross-border Care

Date: Nov 26, 2009
BARRIE - In retrospect, Steve Rider would have taken out a loan if necessary to access gastric-bypass surgery in the United States that likely saved his life.

Battling a lifelong weight problem, Rider had struggled through every diet and workout regime going. At 48, 445 pounds still sat heavily on his six-foot, five-inch frame and the consequences were showing. With Type 2 diabetes, high blood pressure and cholesterol, and an oxygen mask worn nightly for his sleep apnea, Rider knew time was running out to find a lasting solution.

“People said, 'just back away from the table,'” he recalls. “But it’s not that simple.”

When his accountant told him about the OHIP-covered weight-loss surgery available from the Barix Clinic in Ypsilanti, Michigan, he checked it out.

The website has an information link for Ontario residents on its home page.

“Nobody had ever suggested the solution of bariatric surgery before,” he says. When Rider asked his doctor about accessing similar services locally, “my doctor didn’t know anyone to refer me to.”

Instead, the doctor facilitated the paperwork provided by the American specialty clinic so Rider could have the surgery covered by OHIP.

Long waits, unavailable procedures and poor physician access are driving record numbers of Ontarians to seek treatment south of the border and sometimes overseas.

A Metroland Special Report on Cross Border Care shows:

- A 450 per cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a period of explosive growth in new technologies and therapies not covered or available here. The province agreed to fund 2,110 procedures or treatments in 2001, and 11,775 last year.

- Patient demand has created a new breed of health-system navigators, known as medical brokers, who find U.S. options for the growing number of Ontario patients who elect to pay for medical services south of the border.

Medical brokers negotiate discount rates with U.S. centres to get Ontarians faster diagnostics, second opinions and surgery.

Brokers say that for every patient sent south by the Ontario government, there may be up to 10 others who go — and pay — on their own.

- Ontario’s spending on out-of-Canada medical services has tripled in the last five years. Payments in 2010 will balloon to $164.3 million, from $56.3 million in 2005. The province said in last month’s economic forecast it needs to increase health spending by $700 million to cover “higher than anticipated” OHIP costs, including services outside the province.

While out-of-country spending is a small part of the $11 billion OHIP pays for all patient services a year, the increase is significant, Ontario’s health minister says.

“Are we looking at ways to reduce out-of-country? Absolutely yes,” said Deb Matthews, who became health minister last month.

Matthews says her ministry is taking steps to improve services and access across Ontario so fewer patients will need to go to the U.S.

At the same time, though, the ministry continues to negotiate preferred rates for Ontario patient visits to U.S. health centres, the Metroland investigation shows:


- Ontario has become a major contractor — a bulk buyer — of American health services this year.
Since spring, the ministry has entered into funding contracts with U.S. hospitals, imaging clinics and residential treatment centres. It has these “preferred provider” contracts in place with about 40 American medical providers now — and is accepting solicitations from others. Contracts cover diagnostics, cancer care, bariatrics and adolescent behavioural disorders.

The ministry says the agreements ensure “more immediate services for patients whose health is at risk.”

It has declined to release details of any of the agreements.

- The province does not track the number of Ontarians who cross the border for care on their own, never seeking government pre-approval or reimbursement.

But major U.S. medical centres contacted by Metroland — including Detroit’s Henry Ford Health System and the Mayo Clinic — say both government-funded and private-pay patient lists are growing.

The Mayo Clinic, which sees about 600 Ontario patients a year, says top reasons include wait times and diagnostic evaluations “when they’ve exhausted options in Canada,” says Mariana Iglesias of the Minnesota-based clinic.

OHIP’s pre-approved funding program for out-of-country care is supposed to fill gaps in health care for high-risk Ontarians.

But patients who use the system express repeated concerns — about the time it takes to get OHIP approval, and to appeal if refused.

“I really believe they make it as difficult as possible,” says Janet Nancarrow of Ottawa who is preparing for an OHIP appeal hearing for her 34-year-old daughter, Lisa, who is taking part in a clinical drug trial at the Mayo Clinic.

Her doctors and family say the trial is her only option short of end-of-life palliative care. With no outside help, Nancarrow said, she had to research precedent cases, find expert witnesses and keep up with enormous paperwork — all while accompanying her daughter back and forth to Minnesota for treatments.

“They shouldn’t put families through this,” she said.

- Ontario continues to struggle with wait times. This month, almost 140,000 people are on wait lists just for CT scans and MRIs.

- Wait-time insurance policies have emerged as the industry caught on to public angst. While no industry figures exist to indicate the level of consumer take-up of the coverage, plans are available to reimburse costs of private treatment when policyholders are forced to wait more than 45 days.

Ontario says it has made strides to reduce waits for the priority procedures it monitors. But the Ontario Health Quality Council — which the ministry set up to review provincial progress — says more needs to be done.

“Many Ontarians still wait too long for urgent cancer surgery, MRI scans … and specialists,” the council says in its 2009 report.

Ontario NDP leader Andrea Horwath says the OHIP out-of-country surge has taken on momentum, and that government must stop the southbound flow.

“The government needs to reinvest the dollars that they’re shoving out the door to private providers of health care in the States, and invest that in providing services here at home,” she said.

But in the meantime, patients like Rider see the cross-border option as the best way to overcome their health issues.

Without the OHIP coverage, the Wasaga Beach man says he would not have pursued surgery in the U.S, but has since seen the value in the option regardless of cost.

During the pre-surgery process, Rider did discover similar service in Ontario, but they came with several months wait just for the appointment with the specialist.

“I was told it would take two years to have it done,” he recalls.

Since his April 21 surgery, which reduced his stomach to the size of a golf ball, Rider has lost approximately 188 pounds and is learning new nutritional skills.

Although he has 30 pounds left to lose to reach his goal, he has tested within healthy ranges for his blood sugar, blood pressure and cholesterol, and is awaiting the test that will have him pack away the oxygen mask.

Christine Elliott, Ontario Progressive Conservative health critic, says she wants to know what’s being funded “to know if there are specific trends … to look at the system of delivery of care and where changes need to be made.”

Sheila Acker of the Henry Ford Health System says the Detroit area medical centre has seen its Ontario patient population grow.

Many come for bariatric services (weight-loss surgeries for the dangerously obese, through gastric bypass or banding) provided through one of the preferred-provider contracts the ministry has arranged. But Acker says not having OHIP funding has not precluded people from coming.

“If they are concerned about a health issue and know it will be a long wait, we’re 10 minutes from the Windsor border. If they don’t want to wait for their procedure, that’s who we’re seeing.”
- New technology that’s unavailable in Ontario is also an issue, especially in genetics.

Genetic tests — in which a person’s chromosomes are examined — are widely used now to predict disease and help diagnose illness.

Out-of-country requests to OHIP for such testing have increased 200 per cent in five years.

That’s because Ontario has not kept up, said Dr. Suzanne Kamel-Reid, head of laboratory genetics and director of molecular diagnostics at Toronto-based University Health Network.

“The number of tests available in the U.S.have increased, and we in Ontario haven’t kept up with having the same amount of tests available,” said Kamel-Reid.

Matthews, the health minister, says this is a high-priority issue the government is trying to remedy.

She said the ministry has identified the five highest-volume genetic tests, and is trying to improve access to them here.

When a person has metastatic colon cancer, for example, a test can be done for the presence of a mutation in a specific area of a specific gene. That helps doctors know whether the patient will respond to certain therapies.

But out-of-country care focuses most heavily on patients, not tests.

- Requests by Ontario patients for funding of care across the border have more than doubled in four years. Last year, more than 12,000 applied to OHIP for pre-approval of U.S. procedures, including cancer and cardiac care, up from 5,800 applications in 2005.

Patients also go south because they say they want to be assured their Ontario diagnosis was correct.

Doctors say they understand why some patients balk at finding an option here.

“It’s a socialized system and for 97, 98, 99 per cent of people for their regular, everyday little problems, it’s reasonably good,” says Jeffery Brock, a Montreal emergency physician and cofounder of MedExtra, a Canadian firm that helps patients co-ordinate their care. “You have something that’s a little bit more complex, you want a bit higher standard of care, it’s really not available.”

U.S. medical facilities, such as Baltimore’s Johns Hopkins Hospital, and the UCLA Health System in Los Angeles, say they are seeing more patients from north of the border with complex problems they cannot have solved at home.

“It is growing, mainly in terms of patients that have really highly unique issues, high-complexity cases, and also with people and patients who receive a diagnosis and then would like to make sure it’s the correct diagnosis,” said Raffaella Molteni of Johns Hopkins.

Wait times:
Ministry of health figures show the number of people on official wait lists, on Nov. 1:
MRI scans: 74,867
CT scans: 61,506
Cancer surgery: 5,086
Hip replacement: 3,890
Knee replacement: 8,684
MRIs and CT scans have been among the most-requested U.S. procedures for years — due to long Ontario wait times and proximity to U.S. border-city clinics.
The province reported that the wait for an MRI was 109 days at the end of September. The province’s target wait time is 28 days.

Border cities
Border cities, such as Buffalo, N.Y., are used to medical visits from Ontarians seeking a variety of medical care, some funded through OHIP, and some private pay.
Buffalo’s Roswell Park Cancer Institute is an OHIP-preferred provider that takes Ontarians with pre-approval for three specified types of cancer care.
One of the treatments is for advanced skin cancer. Over a three-year period, OHIP paid for about 70 Ontario patients to receive interleukin 2 treatment for metastatic malignant melanoma.
All the treatments covered by OHIP at Roswell are offered in Ontario. But the province says it sends patients to the Buffalo centre when they are not able to be treated in a timely fashion in Ontario.

Pre-approved OHIP Spending on Out-of-country procedures
09-10 — $164.3 million (estimate)
08-09 — $127.9
07-08 — $101.4
06-07 — $70.1
05-06 — $56.3

[roster]

For pete's sake! They even have a detailed web tool to help patients manage the long wait time for medical care in Canada: http://www.health.gov.on.ca/transformat ... ic_mn.html

Just being self-centered, I should be thankful that as this socialized medicine is being implemented in the U.S., my life span is about over and I won't have to worry about it!

[BlackSpinner]

Not Canada - Ontario. Each province sets its own rules.

Quebec - had wait time insurance available - nobody bought it so they cancelled it.

Besides - so what if we chose to buy services else where? It is still paid for and not coming out of peoples pockets. Ohip is using US services the same way any American insurance company is and expecting the same kind of documentation from its citizens. Where the service is performed is irrelevant.
You have a for profit system and Ontario buy its services - big deal. The provinces have had reciprocal arrangements for this kind of thing from the beginning because of the population density and economic base of each province.

This goes especially for elective surgery. He could just push away from the table, he could get counseling, he took a short cut so he wouldn't have to take the effort to use self discipline, which is why most provinces won't waste bed time on these kinds of services.

[roster]

Quebec - had wait time insurance available -

!!!!! So the dirty rascals knew in advance what they were creating!

[cflame1]

don't be worried about Canadian's... for the most part the Canadian system works a whole lot better than the American one.

And I've lived with both!

[BlackSpinner]

Quebec - had wait time insurance available -

!!!!! So the dirty rascals knew in advance what they were creating!

No they needed time to upgrade the system we had. And nobody bought it. The system is in constant flux due to new discoveries and methods. And just because it is new is no reason to go overboard on it immediately. Lots of medical discoveries have not stood the test of time - like thalidomide for example.

[sronsen]

Sorry, these fear-mongering myths are as false as the "death panels". Look at where I live. I work with a lot of Canadians who get better care than I. Also, my understanding is that the programs in Canada are run by each province and that there are significant differences between those programs. My friends are in Ontario, which, I believe, has one of the better programs. So, treat any generalizations of Canadian care with great suspicion.

[SaltLakeJan]

It has been a 'bout three years since we sold a vacation condo in So Calif. We had about 60 Canadian couples from Alberta Provence who were "snow Birds" They spent the winter in Southern California. The ones we knew best, complained about the wait for critical care. Open Heart Surgeries, Hip and knee replacements. We go back for few days each year.. Get to visit with most of the Canadians. They were still complaining 'bout their health care. Said it was getting more restrictive.. Our friends represent a very small sample, don't know how majority of those in Alberta Prov. think 'bout their health care.

Jan

[Froro]

AHHHH Alberta. Land of Ralph Klein and the "lets give bus tickets to everyone on welfare and send them to BC" crew. (Yes they really did that).

Alberta is a bit of a wierd Province. Ultra conservative generally. Under Klein he cut cut cut cut spending on any kind of social program, especially health care. I don't know many Albertan's first hand but the ones I do are pretty "American" in their thinking. I can't really explain that properly, but DO NOT (edited, oops) interpret that negatively...it's just a different way of thinking. I haven't done a lot of research into what other provinces do re health care as previously stated, each province controls their own health care dollars and delivery system with reciprocal agreements in place between each other.

The province is going through some big changes now and it's interesting watching it transform. Alberta and Ontario pretty much have a hate on for each other historically so it's hard to call. (Blame Trudeau...and maybe hockey)

Don't worry about us though, we are managing quite fine.

[So Well]

I don't think that article is conclusive.

[-SWS]

My guess is the incentive to spawn this separate thread came about from my post here.

I find it interesting that the third-hand journalistic political anecdote above, highlights one man's failure to procure bariatric surgery in Canada---as if patient message boards aren't also absolutely filled with first-hand accounts of Americans also failing to procure much-needed bariatric surgery.

[Kiralynx]

This goes especially for elective surgery. He could just push away from the table, he could get counseling, he took a short cut so he wouldn't have to take the effort to use self discipline, which is why most provinces won't waste bed time on these kinds of services.

I'm sorry... but speaking as one who has battled obesity since my system was screwed up by doctors in 1976 (prior to that, I weighed 135 pounds), there is nothing which makes me more furious than to hear,

"Quit stuffing your face and lose a little weight... then it will all clear up," or "Try getting a little exercise... like pushing yourself away from the table."

That is what I was told when I presented with inability to sleep because of the pain in my hips, which only occurred when I was sleeping.

That is what I was told when I presented with jaundice, and back pain, and I ended up, two months later, with "emergency" gall bladder surgery.

That is what I was told when I presented with symptoms of uterine cancer.

The fat person is the new nigger, the new flip, the new guido, or honky -- and the derogatory attitude, the vicious jokes and prejuidice are the same. Totally unacceptable.

PS: I've lost 180 pounds. I can't seem to lose the remaining 100. Bariatric surgery is NOT an option for me because I've spent 8 years straightening out the mess birth control pills made of my gut. I eat a lousy 1500 calories a day. My caloric output is between 2500 and 3000. And I'm not losing weight. So this "just control yourself" is totally unacceptable to me.

[cinco777]

I eat a lousy 1500 calories a day. My caloric output is between 2500 and 3000

I'm at a loss on this statement. How can a person not lose weight if they burn up to two times the calories that they are consuming?

When I burn more calories by running, fast walking, or hiking longer distances, I have to eat more or my weight drops below 150 lbs (I am 6' tall). Below 150 lbs is a No No for me, and I make a conscious effort to eat more. Eating more gets my weight back to my normal range of 152 - 156 and I can continue my ramped up exercise program as long as I eat "more".

[roster]

I find it interesting that the third-hand journalistic political anecdote above, highlights one man's failure to procure bariatric surgery in Canada---as if patient message boards aren't also absolutely filled with first-hand accounts of Americans also failing to procure much-needed bariatric surgery.

OK, now I have read the bariatric patient anecdote. It added nothing to the article for me.

Of course the journalist put it in there because "human interest stories" sell newspapers and the facts and numbers in the rest of the article won't sell many copies.

[roster]

I eat a lousy 1500 calories a day. My caloric output is between 2500 and 3000

I'm at a loss on this statement. How can a person not lose weight if they burn up to two times the calories that they are consuming?

Yes, I would like to understand that also. I repeated that mantra (burn more than you eat and you will lose weight) to a GP friend recently and he told me the human body is not as simple as a machine and that this rule does not hold. We were interrupted before he could explain it to me.

Maybe K can enlighten us on the science.