Medical Tourism to the USA

Medical TourismThousands of Canadians come to the USA for their surgeries, despite the fact that the country has an excellent system of universal healthcare for all its citizens.

There is a strong belief in the US that a Canadian type health care system is a panacea to America’s health problems.

Some Healthcare experts in the US (especially those who have never sought healthcare in Canada) seem to think that such a single payer system will provide for equitable, rationale and fair deliver of healthcare to all Americans.

So what gives? Eh? Why do Canadians come to the USA?

A Primer on Universal Healthcare in CanadaCanadian Flag

The present day Canadian healthcare system evolved about half a century ago in 1962.

The healthcare system was based on five basic principles that were mandated by the Canadian Healthcare Act and included the following:

  • All Canadians would have access to healthcare
  • The basic medical services including preventive care would be included
  • The system would provide healthcare to all Canadians irrespective of their financial or social status.
  • The system would be portable, meaning a Canadian living in one province could move to another province and have the same medical coverage at no cost
  • The healthcare system would be administered by each province in a transparent manner.

The Canadian Health Act further stated that all provinces must provide it residents the essential healthcare services.

What this means is that if you went to a Canadian hospital, you would not need a credit card but a Canadian healthcare card- if you did not have that on you, sometimes your driver’s license or another ID would do just as well- a system based on trust and honesty (unfortunately this honesty system does not work anymore because many tourists have been abusing the system).

For the first thirty years, the Canadian Healthcare system worked great- the population was less than ten million and there were enough hospitals and doctors.

However, rumblings of dis-satisfaction started to appear in the mid 80s when the country was seeing an increase in immigration but no new hospitals and limited number of physicians. Plus, the baby boomers were getting to a retirement age and needed more healthcare services for their chronic ailments.

The other thing to note is that in Canada almost 90% of physicians are general practitioners and only about 10% are specialists. These general practitioners are the gate keepers of healthcare- they decide when you get a referral to a specialist and when; and this wait can be very long irrespective of the patient’s ailment.

Dr. Nakul Karkare - NY Orthopedic SurgeonSo how does it work?
One can go to any hospital for emergency treatment, elective medical treatment or a surgical procedure. The number of times one can see a physician or go to the emergency room is not restricted- the only problem is the long wait time and the PARKING FEE.

All Canadians hospitals charge exorbitant parking rates ($4-$8 for 45-60 minutes is the norm). These parking lots are run by the administrators and bring in hundreds of millions of dollars each year.

For individuals who are unemployed, seniors, disabled or living below the poverty line, the local provincial government do provide both social and healthcare benefits such as low cost prescription medications, basic dental coverage and limited rehabilitation services (Kracker 2001).

However, like the US system the Canadian single payer system does not cover plastic surgery for cosmetic reasons: if you want bigger boobs or a wrinkle free face, then you have to pay for it.

Other than that, if you are sick and need admission, you will be admitted and not charged any money- of course because of lack of beds you may have to sleep in the ER (Puxley,  2013).

How is Canadian Healthcare Funded?
Money and pillsThe Canadian health care system is based on a “Single Payer” model; this means that all the money for the healthcare costs come from the federal government.

The federal government than administers a lump sum to each province based on the population and need (Irvine & Ferguson 2002).  It is left up to the provinces to manage how to disperse the money and what services to offer.

Canadian healthcare professionals work either in private practice or for the local government hospitals. There are no private hospitals like in the USA. Every physician who sees a patient bills the local government for services delivered.

Unlike the USA, very few health insurance companies exist in the Canada and they only cover extra services like dental care, extended rehabilitation, podiatry or visits to the optician (none of these services are covered by  the Canadian healthcare act).

So what are salaries of Canadian physicans?
Standing on piles of cashThere is a false belief by many Americans that Canadians healthcare providers are poorly paid. The latest data reveal that a general practitioner makes over $300,000 a year and there are many ophthalmologists who make several million a year (Picard, 2013). Unlike the USA, running a healthcare practice in Canada is also a lot cheaper.

The reason is that there is less extensive paper work and one does not have to deal with several hundred insurance companies trying to get preauthorization. In addition, Canadian healthcare providers do not spend enless hours on the phone trying to speak to a health insurance provider to determine which healthcare service is covered.

As a patient, as long as you are first in line, the healthcare service is not much different to that obtained in Canada. However, there still are disparities in the quality of care depending on where you live in Canada. Canadians who live in rural parts of the country tend to get inferior care chiefly due to lack of facilities and healthcare workers (doctors do not like to work in provinces where winters last 9 months)

What about medical malpractice in Canada?
Another fact about Canadian healthcare system is that medical malpractice litigation is unheard off. This is not because Canadian physicians are more skilled or smarter- the reason is that it is difficult to sue the single payer which is the government. Plus, most candian physicians tend to protect their interests and rarely act as “gunslingers” for lawyers against other physicians.
legal
Medical negligence and injuries to patients by surgeons are quite common in Canada- the one reason why Canadians do not sue doctors is because they some how feel that they are getting free healthcare, so their expectations from Canadian doctors are less.

One recent media report indicates that close to 70,000 patients in Canada suffer serious PREVENTABLE injury at the hands of doctors, and close to 23,000 die because of “adverse events.”  There is a general belief that medical errors are much higher in Canada despite many efforts to introduce quality control and safety into the system.

Like most things in Canada, there is little transparency and the medical establishement rarely acknowledges these errors. In most cases, it is stated that a review will be conducted and an anti-septic bandage is applied to sooth the public. Most cases of medical injuries and negligence are hidden away and invisible from the masses. Even when malpractice cases ocur, the financial awards are minuscle and never include lifetime costs- thus medical insurance for Canadian doctors is also very low (Robinson 2008).

Funding of the Program
So who pays for the Canadian healthcare? There is a myth of gigantic proportions peptuated by the Canadian Government that Healthcare is Free for Canadians. This is a major Lie. While it is true that the major funding for all healthcare services comes from the federal government, one has to ask is where does the government get its MONEY? Well, it comes from taxes.

taxesCanadians are some of the most highly taxed people on this planet- there is absolutely nothing free in the Canadian healthcare system. On average, a working Canadian will pay anywhere from $4,000-$9,000 each year just for healthcare. The amount of taxes depend on the salary.

This is not much different from the US healthcare premiums which average about $6-$12,000 a year. Apparently many Canadians do not know how to read their tax slips and never understand those large deductions.

> So what are the Negatives of the Canadian Healthcare System

Long Waits:
Data released by Statistic Canada in 2001 revealed that the government spent about $3,000 per Canadian for healthcare, which is similar to what a healthy american pays for his premiums. So one would think that the health system in Canada is efficient and fantastic? Well one should try walking in to any ER or try to see a specialist anywhere in Canada- that alone will reveal how bad the system is.

linesThe most common complaint by most Canadians is the long delays to see a specialist or waits in the ER. Average wait times in the ER can vary from 8-24 hours-irrespective of the time or patient emergency (Chua 2005, Pipes 2004). Even in the ER, it takes hours before a physician will attend to your needs and if you require admission, be prepared to sleep in the corridor for weeks- because there are usually no beds in  most hospitals (Hildebrand, 2014).

Delays & delays
When it comes to getting a surgical procedure, there are long delays. Unless you have an emergency, you are most likely going to wait (Esmail & Walker 2005). Waiting times for neurosurgery, open heart, urology and orthopedics can be as long as 6-12 months- even if you have a life thtreatening disorder or, cancer.

There are more MRI and CT scans in nearby Buffalo, New York than in the entire province of Ontario which is 20 times large. To get an MRI, you may have to wait anywhere from 2-6 months. Hence it is not rare for many Canadians to drive to the US border and get a CT scan or MRI in an american hospital.  In fact the province of Alberta even reimburses patients who are seeking medically necessary surgery or service not available in Canada (Cihak 2004).

Prescription drugs:
drugsCanadians pay some of the highest price for prescription drugs because there is no univeral drug plan. For most Canadians, the pharmacists usually prescribe generics and drugs that were developed 30 years ago.

Only people who have extra company insurance get the latest prescription drugs. If a individual wants the latest drug, he or she has to pay out of pocket.

The cost of prescription drugs in Canada is astronomical and can easily each hundreds of dollars per month.

Reports that many Canadians do not fill their prescriptions or take their medications for chronic disorders are common.

Care for seniors

seniorThe one major area of concern today is how the healthcare system looks after the seniors.And judging from the reports, more than 60% of seniors feel that the wait to get in  a nursing home is way too long. It takes an average of 6-12 months before one can get a place.

More important, many seniors worry about access to high quality nursing homes- complaints of poor care and negligence of long term care residents are daily events.

Many feel that the government has simply neglected seniors leaving them without any resources. In 2015, to get a senior in a long term facility was associated with a 6-18 month delay and exorbitant monthly costs.

So how is the system today?

screamOver the past decade, multiple surveys indicate that Canadians have more complaints about the healthcare system than the year before.

And in 2015, the overall public sentiments were that the healthcare system needed to be upgraded, overhauled and refurbished.

The majority of Canadians who were surveyed in 2015 suggested that the healthcare system was not safe and worsening rapidly- these sentiments were not helped by almost weekly reports about prolonged waiting times in the ER and an inability to see specialists for months.

Almost every Canadian knows a friend or a family member who is unable to afford the exorbitantly priced medications and as a result has stopped taking the medication or delayed renewing the prescription.

These unfortunately are the hard facts about the healthcare system. The public seems to have lost confidence in the hospitals and long term healthcare facilities. In 2015, there were countless reports of seniors not being able to find a place to stay and there were numerous cases of iatrogenic infections and falls in hospitals all over the nation.

In fact in the province of Manitoba some patients waited more than 24 hours and died in the ER.  Today concerns for the healthcare system had become a national priority, even topping unemployment, taxes and corruption.

In Conclusion

doctorWhat is remarkable today is that more than ¾ of Canadians have lost faith in the healthcare system.

While they are more inclined to believe doctors and nurses, most Canadians have grown distant from the hospital administrators because of their unrealistic approaches to healthcare.

With the introduction of electronic medical records to improve efficiency in the system and eliminate fraud, most people believe that there are still too many security and privacy issues that still to be sorted out.

The one thing that most Canadians are hoping for 2016 is that the hospitals get rid of the expensive parking, which has been gouging billions of dollars from Canadian for decades. Hospital administrators seem immune as to how this is affecting patients and their families. Unless something drastic happens, 2016 will follow the same trend as 2015.

There is no question that a single payer system has many benefits and cheap but in reality it is an inefficient system of delivering healthcare. Government based programs are always fraught with bureaucarcy and this also applies to the Canadian Healthcare system.

Like all Western nations, Canada has seen a large increase in its aging population and newer advances in medicine and surgery continue to be expensive. To counter this explosion in health care budget demands by the provinces, Canada has found a new way to control health care- Rationing (Gratzer 2002). If you are old and need a hip replacement, pacemaker or a corneal transplant, you are not going to get it.

References:

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