A flailing U.S. economy has helped push down prices for medical procedures, allowing middle class Canadians who previously couldn't afford it to head south for heart operations, hip replacements and other procedures.
Open-heart surgery once cost upwards of $100,000 in the United States, but a triple bypass can now be had for as little as $16,000 U.S. And there are bargains on hip and knee replacements too: the going rate of $53,000 can be negotiated to less than $19,000.
While no one tracks how many Canadians travel to the United States for medical care, the issue has prompted university studies in both countries. And medical brokers - of which there are about two dozen across the country - say the numbers of people travelling for care are up.
"More and more facilities are contacting us, saying, 'How can we get in on the action,' " said Rick Baker, founder of Timely Medical Alternatives, which has seen revenues more than double over the past year. "We have negotiated prices that are rock bottom."
A troubled U.S. economy, a health-care system with empty beds, and a strong Canadian dollar have created medical bargains for people who have the cash. They are finding treatment that once cost as much as a house is now available for the price of an economy car.
Canadian patients paying upfront means less paperwork; administration is one reason U.S. health care is so costly.
"It's an industry that's going through the roof," said Mark Semple, president of Vancouver-based Passport Medical. "It's wait times, it's cost, it's price, it's quality and accessibility."
Retired accountant Gary Davidge of Calgary started looking into hip replacements two years ago when they cost $45,000 U.S. in Arizona. When the arthritis pain in his hip intensified in December, a medical broker found him a price of $18,800 in Montana.
Although Mr. Davidge's preference would have been to have his operation at home funded by Canada's public health system, the average wait was a year to 18 months, and no one could tell him with certainty when the surgery would take place.
"Hip replacements are a big improvement in one's life," said Mr. Davidge, 67, who is in rehabilitation in Calgary after his Dec. 29 operation. "For whatever reason, they can't afford to get everybody caught up. Forcing people to wait a two- or three-year time frame is not fair."
Joint replacements - hip and knees - are the most frequent procedures Canadians have in U.S. hospitals, said Mr. Baker. That is despite a $5.5-billion federal initiative to reduce waits for joint replacements and four other procedures. Patients also frequently travel for spinal and heart procedures.
Mr. Baker said he has sent about 3,500 patients to the United States for care over the past eight years. He used to have to persuade hospitals to drop their prices, but now they contact him and offer to match low prices he has negotiated elsewhere.
For example, when Oklahoma Heart Hospital in Oklahoma City - which boasts one of the lowest prices for cardiac-bypass surgery - opened a second $98-million U.S. facility in the same city, it contacted Mr. Baker wanting to get some of his business. He told them he already had a hospital that did those operations for $16,000 U.S. in Wichita, Kan.
"I said, 'Look, here are the prices we're getting at this other hospital. We would dearly love to send them to you, but the price is the price and people can't afford more," Mr. Baker said in a telephone interview from Vancouver. "And they said: 'Until we can fill this hospital, we will match this price.' "
Oklahoma Heart Hospital spokeswoman Cindy Miller said that while the facilities are busy, operating seven days a week, there is always room for more patients. The hospital's heart-bypass operation for uncomplicated cases costs $22,000 U.S. and has one of the lowest death and complication rates in the United States.
The institution can still make a profit on that low price as it does a high volume of procedures that are "cost efficient and without a high complication rate," Ms. Miller said in a telephone interview from Oklahoma City.
Leigh Turner, associate professor of the University of Minnesota's Center for Bioethics & School of Public Health, said the U.S. health-care system is unusual in that it has an oversupply of hospitals and clinics - yet 50 million Americans have no health insurance.
"They market to international patients and prices are often negotiable," he said, "because a filled bed is better than an empty bed and some revenue is better than no revenue."
He and others are using records from the Mayo Clinic, Cleveland Clinic and University of Pittsburgh Medical Center to study whether the number of international patients, including Canadians, has increased over the past three decades and what prompts them to come.
"Our guess is that the numbers from the 1980s to now have climbed, the number of Canadians has climbed," he said in a telephone interview from Minnesota. "In Canada, you have a problem of every bed occupied, a lack of access. In a lot of places [in the United States]you've got oversupply, a lot of empty beds."
Will Garin, vice-president of marketing and account management for BridgeHealth Medical, a Colorado-based broker, said hospitals and clinics are willing to price their procedures at aggressive rates. He provides an all-inclusive price to patients; if a patient goes in for a single heart bypass and ends up needing two vessels done, that's covered in the original fee.
"We do get enquiries from Canadians, typically if someone is looking to jump the queue," said Mr. Garin.
As part of a study at Simon Fraser University in Vancouver, researchers are asking Canadian patients, why they travelled out of country for care. The answer wasn't simply to avoid long waits; they also wanted procedures not readily available here. Most didn't use medical brokers.
"The notion of the wealthy travelling abroad, it's not necessarily the reality of what's happening," said Valorie Crooks, head of Simon Fraser University's medical tourism research group. "It's not just something for the rich."
When Rick Wood of Nanaimo, B.C., had chest pain several months ago, his family doctor made an appointment for him with a heart specialist. But he faced a two-month wait for a diagnosis; increasing pain made him shop in the United States for care.
The 66-year-old owner of a fishing lodge had a triple bypass in Wichita in January that cost $18,000 U.S, including diagnostic tests.
"I think my life was worth more than waiting two months and hoping for the best," said Mr. Wood. "Our medical system should be shipping people down for that price."