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Health See other Health Articles Title: Special Report: Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home First in a Three-Part series By Melinda Dalton, Joe Fantauzzi and Matthew Strader 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? Lisa Nancarrow of Ottawa found her last glimpse of hope in a clinical drug trial in Minnesota after Canadian doctors told her they had nothing left to treat the tumours encasing her organs. Brandon Taylor of Hamilton went to Florida for microsurgery after long wait times at home threatened to prolong his excruciating back pain. Rev. Robert Shorten went to a Buffalo hospital for prostate cancer treatment when a lack of spaces in Ontario facilities left the Burlington man facing a six-week delay. Tyler Christie of Cambridge is waiting on DNA test results from an American lab to solve the mystery behind his collapsed lungs because the wait for a geneticist in Ontario is up to two years. Some paid out of pocket, others were reimbursed by Ontario taxpayers. All say they went to the United States for care because they had limited options or no other choice. They are not alone. 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 themselves. 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. • • • WAIT TIME INSURANCE: What it is: A privately obtained insurance that allows Canadians who have excessively long waits for procedures to obtain services at private U.S. clinics. What it costs: Monthly premiums for wait-time insurance range from $100 to $200 a month. How it works: Typically, benefits kick in when a covered person is on a wait list for more than 45 days. Coverage includes costs for diagnostic tests and treatment for hundreds of medical conditions. Coverage is subject to terms and conditions of the particular policy. • • • Others Go South Ontario has two major agencies that sometimes send Ontarians south of the border for care. Critical: It's a 24-hour, publicly funded emergency referral service for hospital-based Ontario physicians. It finds spots across the province for patients in need of critical care, last year handling 15,319 cases. About 400 of those went to the U.S. for cardiac, neurosurgery and other kinds of critical care. WSIB: Workplace Safety and Insurance Board, Ontario's public worker compensation system, approved about 100 claims for out-of-country hospital and physician services in 2008 for just over $900,000. • • • WAIT TIMES SNAPSHOT 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. • • • HOW PRE-APPROVAL WORKS Ontario Health Insurance Plan's out-of-country pre-approval system is supposed to be a safety net for patients. An external review of the program in 2007 - prompted by the Ontario Ombudsman - said there were some weaknesses in the program that should be strengthened, to ensure that out-of-country care continues to "help fill gaps" here. Ontario residents who apply for pre-approved funding from OHIP must meet a number of conditions. For OHIP to pay, the service must be unavailable in Ontario, cannot be experimental and must be found to be medically appropriate. However, if a delay would cause irreversible tissue damage or death, out-of-country treatment can be funded even if the procedure is available in Ontario. • • • THE NUMBERS Out-of-country applications pre-approved by OHIP 2008-09: 11,775 2007-08: 8,885 2006-07: 7,021 2005-06: 5,549 2004-05: 4,533 2001-02: 2,110 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 *Pre-approved by OHIP LINKS: Ontario Wait Times ontariowaittimes.com OHIP pre-approval health.gov.on.ca/english/...untry/prior_approval.html Health Services Appeal and Review Board www.hsarb.on.ca Ontario Health Quality Council www.ohqc.ca
Poster Comment: Remember that Ontario is only 1 of 10 Canadian provinces so total numbers of Canadians who come/are sent by their provincial governments to the USA to get timely, proper health care is much greater than the figures cited in this article. Yesiree, universal health care - which Obumski and his Dem Party comrades want to force on us - sounds very yummy, indeed. I wonder where Canadians and Americans will be able to go to get good health care when they are sick, after Obamacare takes effect stateside? Hmmmm....a scary prospect, because the answer maybe "nowhere."
Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest Begin Trace Mode for Comment # 4.
#2. To: scrapper2, all (#0)
Indeed. Last Thursday my primary care doc ordered a CT for me: it was done Monday. I'm thinking that kenyankare would have done it by Friday...of 2010.
We have to look around for this bit of information but it is buried in the huge bloated health care bill. Passage of the bill will...INCREASE...the shortage of doctors nationwide as it will increase the number of patients, increase the number of patient visits...and there will be less Federal money spent in training doctors. Built in failure, at our expense, but what the hell, its free, right????
I know that we bitch a lot about our various .govs here, but can anyone come up with an example of what any of them excel at? And don't say taxes and losing wars. Thanks.
#5. To: Lod (#4)
Glad you asked... Yesterday I read an excellent essay about government. Their main thrust was that no matter how good a government is when founded...they always go corrupt over time... They also stressed that the reverse is NOT true...a bad government never becomes a good government. It seems we have been lucky ours has lasted this long.
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