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Medical tourism fees for international patients return little cash to hospital

Debra Owusu cleans rooms after a patient was discharged at Sunnybrook Health Sciences Centre in Toronto, Ontario Thursday, November 21, 2013. The vast majority of the money that Sunnybrook Health Sciences Centre has made so far through its international patient program has been used to cover expenses, including insurance, leaving $16,000 in revenue to be plowed back into the general operations of the hospital.

Kevin Van Paassen/The Globe and Mail

A major Toronto hospital whose fledgling medical-tourism program is being closely watched across the country has now treated eight international patients who paid a total of $300,000 in fees – but just 5 per cent of that money is being re-invested in care for Canadians.

The vast majority of the money that Sunnybrook Health Sciences Centre has made so far through its international patient program has been used to cover expenses, including insurance, leaving $16,000 in revenue to be plowed back into the general operations of the hospital.

The profits could increase in the future if the new program is scaled up, but the paltry early returns raise questions about how financially beneficial it is for cash-strapped hospitals to treat a small number of wealthy or well-insured foreign patients.

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"It doesn't seem like a particularly large return," said Ryan Meili, vice-chair of Canadian Doctors for Medicare, which has expressed concerns that medical tourism could pave the way for well-off Canadians to jump hospital queues. "Maybe the revenue stream is turning out to be more of a trickle."

Sunnybrook launched its international patient program in late 2013 as a pilot project that will be reviewed at the end of this year. In the meantime, the hospital is treading carefully, ensuring it does not displace Ontario patients as it works out the kinks in its new model.

"We are proceeding with this quite cautiously to make sure it works for everyone involved so it's less about revenue and more about understanding how the processes involved work," Craig Duhamel, Sunnybrook's vice-president of communications and stakeholder relations, said by e-mail.

Seven of Sunnybrook's eight international patients received outpatient cancer treatments; one was an ophthalmology patient. All were from Europe or the Caribbean.

Concerns about Sunnybrook's new venture and another Toronto hospital network's much larger and longer-standing international patient program spurred Ontario's former health minister to order an informal review of medical tourism last spring.

The new minister, Eric Hoskins, has picked up that investigation, and The Globe and Mail has learned that last month the Health Ministry sent a questionnaire to hospitals across the province asking them to describe the extent of their "international activities."

The 11-question survey provides a glimpse of the issues Queen's Park is exploring in its review, including which hospitals treat international patients on a non-emergency basis, which provide health-care consulting services to foreign governments or organizations and how much money they earn from those activities.

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The survey also asks if hospitals have incurred bad debt from international patients who have failed to pay their fees and if the international patients they treat are linked to overseas consulting contracts.

"What we need, rather than a lot of anxiety and rhetoric, is information," said Matthew Stanbrook, deputy editor of the Canadian Medical Association Journal, and the author of an editorial last month urging the province to commission a study of medical tourism. "Gathering this information is a good step toward that, but only if it's going to be revealed to the public in a transparent matter."

Dr. Hoskins pledged in a statement Thursday to make the survey results public when the review is complete.

All Canadian hospitals treat foreign patients in emergencies. But Sunnybrook and Toronto's University Health Network treat international patients who travel here specifically for care they pay for out-of-pocket or through government or private insurance. Both invite overseas patients to apply for care on their websites.

UHN rakes in millions through its program, which it formalized three years ago. In the last six months alone, UHN has treated 51 international patients who paid a total of $4.5-million in fees.

Nizar Mahomed, the managing director of UHN International, said the program's profits have made it possible for the network's four hospitals to offer more care to Canadians.

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"It's a source of additional revenue to invest back into Ontario health care," Dr. Mahomed said. "But I think it has to be done with great care to make sure it's done correctly."

UHN has opened up an extra operating-room day and two extra beds at Toronto Western for international patients, which Ontarians wind up using 85 per cent of the time, he added.

But Doris Grinspun, the chief executive officers of the Registered Nurses' Association of Ontario, said she has heard reports from her members of locals being bumped for patients from abroad, something Dr. Mahomed said does not happen at UHN.

"We should never engage in soliciting patients from abroad simply to turn on more dollars," Ms. Grinspun said. "It certainly will have implications for wait times for our own patients. If someone comes from abroad and pays, of course that person will not wait."

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Kelly Grant is a health reporter with The Globe and Mail. More


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