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When high-school teacher Bob McDonnell faced a staggering 21/2-year wait for hip-replacement surgery in Ontario, he went to the popular medical tourist destination of Chennai, India, where he received first-rate care at a Third World price.

Now, the Ontario government has been ordered to reimburse his medical costs after the Health Services Appeal and Review Board ruled that the teacher not only faced a delay but also that he might not have ever been able to obtain the hip-resurfacing surgery here.

“The evidence persuades us that it was necessary for him to travel out of country for surgery not only to avoid a delay but, in fact, in order to access the surgery at all,” according to the Jan. 22 decision.

While moneyed Canadians have long travelled at their own expense to obtain timely medical care, usually to the United States, the middle class is now finding ways to bypass lengthy health-care queues — on a budget.

For Mr. McDonnell, it meant travelling to Apollo Specialty Hospital in Chennai, located in southeast India, where he underwent metal-on-metal hip-resurfacing surgery in July of 2005, which he financed with a line of credit. The operation preserves more bone than a hip replacement, is less invasive and is typically done on younger or more active patients.

Though the surgery is performed in Canada, it is not done nearly as often as a total hip replacement. In the case of Mr. McDonnell, who required surgery after his left hip become arthritic, he could obtain neither operation in a timely manner.

Mr. McDonnell's waiting-time problem was further compounded when his family doctor retired.

Faced with a long queue for a hip replacement after visiting his first orthopedic surgeon, he learned of two other doctors who did hip-resurfacing surgery in Ontario. However, he could not obtain an appointment with either because he required a referral from a family doctor, which he no longer had.

“It's ridiculous you have to go somewhere else for this treatment,” said the 53-year-old biology and science teacher who heard this week that he had won his case. “I wasn't prepared to sit by and get worse and worse.”

And that is what led Mr. McDonnell from his home in Courtice, Ont., east of Toronto, to India, where the price of health care is a bargain.

Although the actual cost of the surgery was $7,000, his out-of-pocket costs totalled $11,000. He said the remaining $4,000 was spent on flights, accommodation, food and related expenses.

In a telephone interview from Chennai, India, the orthopedic surgeon who operated on him, Vijay Bose, said he operates on five Canadians a month — some of whom face long waits at home. In the past few years, he says he has operated on 65 to 70 Canadians.

The danger of lingering in a queue for hip-resurfacing surgery is that the bone can become “so damaged, there won't be enough bone to do the procedure,” Dr. Bose said.

Waits for joint replacement have been a chronic Canadian problem, which is why the federal government in December of 2005 unveiled clinical benchmarks, setting the maximum length of time patients should wait for treatment in five priority areas. It said patients should face a maximum, six-month wait for joint replacements.

The benchmarks were established with the provinces in exchange for signing a $5.5-billion Wait Times Reduction Fund, part of a $41-billion health accord created by the then Liberal government.

Since then, waits for joint replacements have dropped.

In Ontario they have come down 20 per cent in the past year, although queues in some areas remain long.

Specifically, 90 per cent of patients requiring hip replacements had them done within 278 days in Ontario, according to figures for October and November of 2006.

However, waiting times vary widely, with the queue at St. Joseph's Health Care, London, being the shortest in the province, with 90 per cent of patients obtaining their hip-replacement surgery in 41 days. Compare that to Lakeridge Health Corporation in Oshawa, where Mr. McDonnell was queued: 90 per cent of patients had their surgery done in 370 days, during the same period.

“We believe patients should not be waiting long,” Brendan Lewis, president of the Canadian Orthopaedic Association, said in a telephone interview from Corner Brook, Nfld.

Dr. Lewis said patients should wait no longer than three months for a first appointment with an orthopedic surgeon.

Once it has been determined that a total hip replacement is required, patients should wait anywhere from two weeks to a maximum of six months for an operation, depending on the severity of their condition.

George Eapen, chief executive officer of Apollo hospitals, Chennai division, said yesterday that most Canadians travelling to India for hip replacements, shoulder and spinal surgery and cancer treatment often do so because of lengthy health-care queues.

“There's been a surge of Canadian patients over the past four years,” Mr. Eapen said in a telephone interview from Chennai on Friday.

Yasmeen Sayeed, president and chief executive officer of Surgical Tourism Canada Inc., a Vancouver company, was in Chennai on Friday with seven Canadians, all of whom are obtaining medical care.

She said it would be economical for governments to reimburse Canadian patients lingering in health-care queues to travel to India.

“The government could get rid of the wait lists and also save a lot of money,” she said in a telephone interview from Chennai.

Indeed, Ms. Sayeed offers the medical version of an all-inclusive package, where patients seeking hip-resurfacing surgery pay one price — $14,500 — for a visa, air fare, surgery, hospital stay and two-week recuperation in a beach resort or five-star hotel.

“We've been constantly lobbying the governments, to pay them [patients] the surgical costs,” Ms. Sayeed said. “Each provincial government should be paying.”

In the case of Mr. McDonnell, he sought preapproval from Ontario to have his operation in India funded.

The Ontario government refused, saying hip-resurfacing surgery was not a “generally acceptable form of treatment,” according to the decision.

Ultimately, the Ontario government was ordered to reimburse Mr. McDonnell. Typically, patients are compensated for surgery and other medical costs but not transportation and lodging.

“I used a line of credit to pay for the surgery. I thought my health was important enough to do that,” Mr. McDonnell said, adding that he scheduled his operation in summer so “I didn't have to miss a day of teaching.”