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Canada Research cited by Trump on numbers of Canadian medical tourists criticized

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The number of Canadians who travelled abroad for non-emergency medical treatment dropped slightly last year, according to a new report from a think tank whose past research Donald Trump's campaign cited to support his debate-night claim that when Canadians need "a big operation," they often head for the United States to avoid long waits at home.

The Fraser Institute's latest report, released Wednesday, found that an estimated 45,619 Canadians left the country for elective medical care in 2015, down about 13 per cent from 52,513 in 2014.

That works out to about 1 per cent of all Canadian patients receiving non-emergency care outside of Canada's borders last year, a minor decrease from an estimate of 1.1 per cent the year before.

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The right-leaning institute's new estimates come on the heels of Mr. Trump name-dropping Canadian health care in Sunday night's presidential debate, and not in a positive way.

The Republican nominee was in the midst of trashing the Affordable Care Act – better known as Obamacare – when he accused his Democratic rival Hillary Clinton of wanting a single-payer health system, which he said, "would be a disaster, somewhat similar to Canada." (Ms. Clinton is promising to improve Obamacare, not implement a single-payer model.)

"And if you haven't noticed the Canadians, when they need a big operation, when something happens, they come into the United States in many cases because their system is so slow," Mr. Trump said. "It's catastrophic in certain ways."

The Washington Post reported that the Trump campaign later backed up that assertion by pointing to the Fraser Institute's estimates on Canadians travelling abroad for medical care in 2014, the most recent year for which figures were available at the time.

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The Trump campaign did not respond to a request for comment.

Even before they became a footnote to an American presidential debate, the Fraser Institute's estimates on wait times and on Canadians seeking medical care abroad have been hotly disputed, with critics calling the institute's methods flawed and its conclusions suspect.

"They don't actually measure how many patients leave," said Karen Palmer, a health-policy analyst and adjunct professor at Simon Fraser University in British Columbia. "They [ask doctors to] guess."

Jeremy Snyder, an SFU professor who contributes to the school's medical-tourism research group, said he was concerned that the Fraser Institute report presents a "very speculative narrative," – namely that long lines at Canadian hospitals and doctors' offices are to blame for patients going abroad for care, even though the think tank did not ask that question directly.

The Fraser Institute draws its estimates from an annual survey of medical specialists about wait times. The survey includes one question about medical tourism: "Approximately what percentage of your patients received non-emergency medical treatment in the past 12 months outside Canada?"

About 20 per cent of the 11,292 specialists the the Fraser Institute contacted responded to the most recent survey.

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Bacchus Barua, a senior economist at the Fraser Institute's Centre for Health Policy Studies, acknowledged the limitations of the survey, but said the findings are still useful given how few data exist on Canadians travelling abroad for elective medical care.

"Let's say it's lower than this estimate," he said. "Does that really change what the issue at hand is? And that's that there are Canadians travelling abroad to receive treatment that they cannot find here."

One 2002 paper, published in the journal Health Affairs and circulated widely online after Sunday's presidential debate, found that when it comes to Canadians heading to the U.S. for medical care, the numbers, "are so small as to be barely detectible relative to the use of care by Canadians at home."

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