Crossing the Border for Care
Frustrated by long waits, some Canadians are heading to the U.S. for medical treatment.
By Randi Druzin | Contributor
Aug. 3, 2016, at 5:46 a.m.
TORONTO ? When Sharon Shamblaw was diagnosed last summer with a form of blood cancer that could only be treated with a particular stem cell transplant, the search for a donor began. A Toronto hospital, 100 miles east of her home in St. Mary's, Ontario, and one of three facilities in the province that could provide the life-saving treatment, had an eight-month waiting list for transplants.
Four months after her diagnosis, Shamblaw headed to Buffalo, New York, for treatment. But it was too late. She died at the age of 46, leaving behind a husband and three children, as detailed by the Toronto Star.
Frustrated with their much-maligned health-care system, many Americans look at the Canadian system with admiration. While promoting his 2007 movie "Sicko," for example, filmmaker Michael Moore called on his compatriots to "push politicians to pass legislation so that [Americans could have] the system they have in, say, Canada."
But such intense admiration may be misguided.
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To be sure, Canada's publicly funded system provides individuals with preventative care and medical treatment from primary-care physicians along with access to hospitals and other important medical services. Universal health care is a source of collective pride in Canada, which boasts one of the highest life expectancies and lowest infant mortality rates in the world.
However, the Canadian health-care system is far from perfect, and its shortcomings are a hot-button topic north of the 49th parallel.
Contrary to popular belief among Americans, health care is not entirely free for Canadians. Dental, ambulance and many other services as well as prescription medications must be paid for out of pocket or they're covered through a combination of public programs and private health insurance. About two-thirds of Canadians have such insurance.
The Commonwealth Fund, a U.S. think tank, released a report two years ago ranking Canada 10th out of 11 wealthy nations in terms of health care. Only the United States fared worse. The report, based largely on satisfaction surveys by patients and health-care providers, placed Canada last in timeliness of care. The United Kingdom was ranked No. 1
Few Canadians would be surprised by that finding. A visitor spending an afternoon in a coffee shop anywhere between Vancouver and St. John's would likely come across at least one person complaining about waiting months for an MRI on his knee or an appointment with an ears, nose and throat specialist.
Canadians seek treatment abroad
The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.
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In citing those numbers in its 2015 report, "Leaving Canada for Medical Care," the organization said difficulties in obtaining timely medical care at home is, increasingly, leading Canadians to seek it abroad. "It is possible [they] may have left the country to avoid some of the adverse medical consequences of waiting for care, such as worsening of their condition, poorer outcomes following treatment, disability, or death," the report says. "Some may leave simply to avoid delay and to make a quicker return to normal life."
Canadians could expect to wait 9.8 weeks for medically necessary treatment after seeing a specialist in 2014, the researchers found, three weeks more than the time physicians considered to be clinically "reasonable."
The public health care system sends some Canadians abroad for treatment partly because of a lack of available local resources, the report says.
[READ: The U.S. does not have the best health-care system]
Ontario, the country's most populous province, provides a good example. The three hospitals that use stem-cell therapy to treat patients with blood disorders and aggressive cancers like the one that Sharon Shamblaw battled are unable to keep up with the soaring demand. So patients are sent to medical facilities in Buffalo, Cleveland, Ohio, and Detroit, Michigan, for the potentially life-saving treatment.
"We don't yet have the capacity to serve all the patients who require allogeneic stem-cell transplants," says Dr. Michael Sherar, president and CEO of Cancer Care Ontario, referring to the treatment that uses donor stem cells. He describes the arrangement with the U.S. facilities as "an interim solution" and says it will likely end within two years, when Canadian centers have the necessary personnel, infrastructure and funding in place. "Working out all these things takes time," he says. "Capacity cannot be increased overnight."
A recent spike in government funding will help matters.
Dr. Ralph Meyer, president of Juravinski Hospital and Cancer Centre, one of the three facilities in Ontario that provide stem cell treatment, says he's not aware of other arrangements like this one, in which Canadians are sent to the U.S. for potentially life-saving therapies because they are unavailable at home.
But Meyer acknowledges that some Canadians head to the U.S. for experimental therapies or faster access to treatment that is beneficial though not curative or life saving. Hip replacement surgery and other orthopaedic procedures are among treatments that fall into this category.
"In a public health system, you have to balance the high desire to get quality-of-life treatment as soon as possible with the need to deliver universal health care in an equitable manner." If the priority is universal health care, Meyer says, there is a risk of wait times.
But not everyone sees it that way.
"Canadians often think that the long wait times and bureaucratic roadblocks we experience are simply the price we pay to have a system that is fair and free? but the world tells us otherwise," journalist Michael Bolen wrote in The Huffington Post. He noted that in the Commonwealth Fund report, European countries with universal health care systems that use a hybrid of private and public models have shorter wait times and are ranked higher overall.
"So we're better than The United States," he wrote, referring to the rankings. "But should we really aim so low?"
