Going South for Health Care
Canadians fed up with long waits for medical care are routinely going to the United States. Should you?

BY GABRIELLE BAUER
FROM MONEYSENSE

When Barry Stein learned the cancer in his colon had spread to his liver, he knew there wasn’t a minute to spare. To save his life, the 41-year-old Montreal lawyer needed surgery—but it kept getting postponed. The reason? Operating rooms were booked solid.

Frustrated at waiting, Stein sought other options. Logging on to the Internet and talking with everyone he could think of who might be able to help, he quickly found what he was looking for: an expert in New York who could perform three treatments to save his liver that were not available together in Canada. Within a week he was lying on an operating table in New York.

That was seven years ago. Today Stein, 48, is still going strong in his law office. “There’s no question that going to the United States saved my life,” he says.

In Canada the average wait for procedures such as neurosurgery is more than four months; for cancer radiation treatment, over two months. The average wait for treatment after consulting a specialist for coronary bypass clocks in at up to 52 weeks, with four to 12 weeks for angioplasty. That’s the reality in our backlogged public health system, according to a recent survey by The Fraser Institute, a think tank based in Vancouver. In the United States, you can often be on an operating table within a week or two of referral to a surgeon.

Why is Canada’s health system in such a bad fix? “There’s simply not enough medical personnel to keep up with the demand,” says Dr. Hugh Scully, a senior cardiac surgeon at the University Health Network in Toronto and past president of the Canadian Medical Association. “Not enough doctors, not enough nurses, and not enough medical technicians.”

Politicians can debate the answer to the problem and editorial columnists can weigh the merits of allowing private health care, but once you understand the terrible reality of Canada’s medical waiting lists, it’s easy to see why people like Stein are seeking fast-track alternatives outside our conventional health-care system. It’s not a matter of being patriotic or unpatriotic. It is a matter, quite literally, of life and death.

Canadian patients who go south of the border report speedier, better service. And you don’t have to be a lawyer like Stein to get it—anybody can find the specialist he or she needs, or gain access to the most advanced technology available. Some strategies may require your ingenuity and persistence, while others will require you to dig deep for cash. Still, as Stein points out, “When your health is on the line, you stop worrying about saving money.” Should you go to the United States for care? Consider these options before deciding.

Work the Canadian system first. Fast-tracking doesn’t always mean going to the United States. Sometimes, getting the care you need is as simple as being more assertive. That’s what Toronto resident Lori Newman discovered. Married to a man with end-stage kidney disease, Newman would refuse to leave emergency rooms until a specialist arrived, and she has walked into doctors’ offices unannounced, convincing them to see her ailing husband right away.

Newman brings no special qualifications to her self-styled job of patient advocate. She’s just a regular person who, fuelled by love for her husband and anger over the care he wasn’t receiving, overcame her reluctance to speak up. Newman insists that anyone can do the same. “Pick up the phone, again and again if you have to,” she advises. “Be respectful, but be insistent, too.” In other words, don’t take no as your final answer.

Like Newman, Fraser Institute Executive Director Michael Walker finds that “the squeaky wheel does get the grease.” You might ask your doctor, for example, if he or she can communicate with hospital personnel to expedite your care. In a recent survey, says Walker, some hospital CEOs and internists admitted to helping people jump queues.

Hooking Up to U.S. Health Care Use a medical brokerage. Looking for a hospital, clinic or specialist south of the border? MedExtra (www.medextra.com) will do the legwork for you. This Montreal-based service has arrangements with more than 4,000 health-care facilities, including the Mayo Clinic and The Johns Hopkins Hospital. Going through MedExtra will save you not only time but money. MedExtra is able to access rates similar to those that U.S. insurance companies and health-maintenance organizations receive. The only requirement: You have to pay your estimated fee to MedExtra at the time of admission. Get a doctor’s prescription. Next to MedExtra, your best resource for U.S. medical info is your physician. Toronto cardiac surgeon Dr. Hugh Scully routinely informs patients about the most respected cardiac centres, especially in the northeastern United States, should they choose to go outside Canada. Often, you don’t need a referral to get an appointment. Surf for surgery. For a U.S. medical-services directory at your fingertips, the on-line Yellow Pages (http://yp.superpages.com) lets you search by type of service within U.S. cities or states. To get the name of a specific doctor, log on to Vancouver-based Medbroadcast Corporation’s web site (www.medbroadcast.com). Scroll down to On-line Resourc-es, then click “Find a U.S. Physician,” which allows you to search by name or by specialty. You should also check out web sites for people who share your medical condition, such as Parallel Journeys for cancer patients (www.paralleljourneys-cancer.com). In addition to checking the Internet, Barry Stein says: “I called friends in the States to see if they knew someone who knew someone. Word of mouth is still one of the best ways to get information.” G.B.

While you’re at it, do some research. If you’re facing a long wait for diagnosis or treatment, says Dr. Cecil Rorabeck, chief surgeon at Ontario’s London Health Sciences Centre, contact your provincial Health Ministry or medical specialists to find out where the queues might be shorter. “It could be the next town or the next province,” he says. Be aware, though, that if you go out of province, you may have to pay for part or all of your treatment.

Being flexible may also shorten your wait. For instance, agreeing to a late-night appointment could get you a diagnostic CT scan in two weeks instead of six. Similarly, ask about facilities that offer after-hours treatment, such as Canadian Radiation Oncology Services in Toronto for prostate- and breast-cancer radiotherapy.

Before you start packing your bags for the United States, find out whether jockeying for faster treatment will actually benefit your health or condition. Dr. Ivo Olivotto, a radiation oncologist at the B.C. Cancer Agency, points out that a study of about 2,000 women who had lumpectomies to remove malignant breast tumours found it was equally effective to begin radiation at any point up to 20 weeks after surgery.

To find out about your own prognosis, speak with your own doctor or seek out a timely second opinion if you can. You can then decide whether to stick out the wait for treatment at home or make a beeline for the border.

Should You Go…
Here’s what to expect: Most Canadian patients assume it’s too expensive to go to the States. While the costs may vary widely and seem hefty to Canadians accustomed to free medical care, some may be within the reach of most middle-class families. For instance, at the Erie County Medical Centre in Buffalo, N.Y., a coronary bypass costs around $26,000, about the price of a new Toyota sedan. When you consider that an Ontario study found that 141 cardiac patients in the province died between 1991 and 1995 while waiting for surgery, the fee may seem like money well spent.

One reason the American system is much faster than Canada’s is that there is greater access to facilities for diagnosis and treatment. Family physician Bill Strang, originally from Canada, now practises in Chattanooga, Tenn. Having seen the health-care situation on both sides of the border, Strang has some good things to say about the American way of doing things. “Investigation and diagnosis are done in a much timelier manner here, partly because so many doctors are willing to work long hours,” he says. The result is that many hospital departments “are able to run almost 24 hours a day.”

For their money, patients in the States get not only faster treatment but more personalized attention. Toronto resident Eleanor Ward sustained multiple fractures in a skiing accident while on vacation in Vail, Colo. She describes the medical treatment she received at a nearby facility as “Rolls-Royce care.” At $60,000, that care did not come cheap. Ward was fortunate to have travel insurance that paid the tab, but not everyone is so lucky.

Still, there are financial options available to ease the blow of a huge medical bill. If you take out critical-illness insurance while you’re still healthy, the policy will pay out a lump sum if you are later diagnosed with a critical condition, such as a heart attack, stroke or cancer, covered by the policy. The payout is yours to do with as you wish: to recoup lost employment income, to invest or to cover private medical treatment anywhere you choose.

What if you’ve already been diagnosed with a critical illness and it’s too late to take out a critical-care policy? Check with your doctor and your provincial Ministry of Health to find out about special programs or subsidies.

For example, when waits for breast-cancer radiation treatment after a lumpectomy started to exceed 12 weeks, the Ontario Ministry of Health and Long-Term Care gave patients the option of travelling to U.S. facilities, on the ministry’s dime, for timelier treatment. Over 1,000 patients took up the offer between 1999 and 2001. Arranging treatment in the States on their own would have cost each of them $15,000 or more, including travel.

Another cost-saving measure is to verify how long your hospital stay would be. Some hospital fees may be higher for certain procedures—and less predictable—than the physician’s fee. For example, while the surgery required to remove a prostate tumour costs only about $1,500 at the Erie County Medical Centre, the related hospital fee will cost you almost $8,000 more. The best medical “deals” south of the border are typically those procedures involving relatively short hospital stays, such as for cataract surgery or the removal of a colon tumour.

For the health of his finances, Barry Stein might have suffered through the ever expanding waiting list for his liver surgery at home since the costs would have been covered by Quebec medicare. He might also have died waiting. For his physical health, Stein is convinced he did the right thing by taking the fast track to treatment in the States. And, in the end, the government had to agree with him. In August 1999 Stein won a court case against the government of Quebec, resulting in his being reimbursed for most of the $250,000 he had paid out to U.S. hospitals.

Stein’s winning verdict is good news for anyone who can’t get critical-illness insurance but could benefit from treatment abroad: It means you might be able to get the government to cover health-care bills you rack up outside Canada. “The government was legally bound to pay for the procedure since the equivalent standard of care wasn’t available in Canada,” Stein explains.

“We were able to prove that it wasn’t.”

Should the provinces be funding trips to the United States for medical services you can’t get here?

Post your comments using the submission box below. They may be selected for inclusion in a future issue of Reader's Digest magazine.

All submissions are reviewed prior to posting. We will post as many comments as possible, though some may be edited for length and clarity.

How Others Responded

PHOTO: © MARIE-LOUISE DERUAZ