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What should I know about seeking U.S. medical care?

The Question: I am in excellent health and rarely require any medical treatment. I last saw a doctor two years ago but should I require care requiring a wait in Canada, I will opt to pay for care in the United States. Other than asking my family doctor, where else can I go?

The Answer: A wait, as you know, doesn't necessarily spell a worse medical outcome – many patients can safely queue for certain tests, procedures and operations – so your question is largely about wanting timely medical treatment or at least having a Plan B should you seek a diagnosis in a pinch.

In the U.S., patients with cash are king: Many hospitals there have the opposite problem of Canada – they have excess capacity. So for those institutions, having a patient in a hospital bed at a lower rate is better than an empty bed.

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Another thing you should know: No one pays the rack rate; expect about a 30-per-cent price cut if paying cash for a procedure. Given the downturn in the economy, I would negotiate hard for an even bigger discount. Don't feel you necessarily have to be in big medical centres of New York and Boston; hospitals in Oklahoma and Montana may pleasantly surprise you with equally impressive outcomes for routine procedures.

There is a tendency to overtreat patients in the U.S. Back surgery is heavily marketed and it can be seductive if you are a Canadian patient facing a one-year wait to see a spine surgeon. But what they don't know is that as many as 90 per cent queuing for that first consult with the surgeon later learn they are not surgical candidates in the first place.

Be cautious of experimental treatments; you want care that is based on the best medical evidence. The only exception is if you have a relatively rare condition – where you will need to find a world-class physician who specializes in that area.

A lot of care can be found online. One website operates a medical-bidding service, allowing Canadian and American patients to post the medical procedure they seek, such as second opinions, diagnostic procedures, knee-replacement surgery or even a new cancer treatment. U.S. doctors come back with custom quotes and their credentials; patients take their pick.

Others patients hire medical brokers, some of whom have good connections and special provider rates with certain U.S. hospitals. But beware: A recent five-year study of medical-tourism companies that operated in Canada found that about half – 25 businesses – had ceased operations by March, 2011.

"Quite a number arrived on the scene then disappeared from view," said Leigh Turner, associate professor of the University of Minnesota's Center for Bioethics, School of Public Health and College of Pharmacy. "If someone goes through a medical tourism company, they may get a better deal and they may not."

If you choose a medical broker, make sure it is an established one that has been around for years. And don't be afraid to shop around; there are huge deals to be had.

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The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to .

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