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File photo of patients at Sunnybrook Hospital on December 5, 2010.

JENNIFER ROBERTS/The Globe and Mail

A major Toronto hospital is piloting a new way to raise revenue in an era of tight health-care budgets: Selling medical treatment to wealthy foreign patients paying out-of-pocket for Canadian care.

Sunnybrook Hospital's board quietly approved an international patient program at the end of last year that has so far welcomed a Barbadian woman who paid about $60,000 for radiation treatment for breast cancer, and a Jamaican man who paid $20,000 for radiotherapy for prostate cancer.

All Canadian hospitals see foreign patients in emergencies, and at least one, Toronto's University Health Network, raises millions treating international patients on a referral basis.

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But Sunnybrook's limited experiment – the hospital is treading carefully, planning to treat fewer than 10 international patients in a one-year pilot phase – is different in that the hospital is openly soliciting medical tourists.

"We've invested in a department of business development who've looked at a number of initiatives. This is one of them," said Michael Young, Sunnybrook's chief administrative officer. "Through our website and such, we are beginning to advertise that we are, in essence, open for business."

Canada's publicly funded health-care system has a strong reputation around the world, and would have little trouble attracting medical tourists, according to a 2011 analysis from Deloitte Canada's health services division.

But opponents say patients from abroad could displace tax-paying locals or pave the way for rich Canadians to buy their way to the front of the queue.

When a Quebec newspaper reported last year that the McGill University Health Centre had performed cardiac surgery on a Kuwaiti woman whose government paid the $200,000 cost, the province's health minister called it "unacceptable" and vowed not to let it happen again, except on compassionate grounds.

"Medical tourism creates a parallel system," said Doris Grinspun, the chief executive officer of the Registered Nurses' Association of Ontario, the professional organization for the province's nurses. "At this point, it's for people outside of the country, but who's to say tomorrow it won't be for people inside the country?"

Mr. Young said Sunnybrook has vowed not to displace Ontario patients. The hospital plans to treat foreigners only where it has extra capacity or staff on standby, as it does on its burn unit. The profits could be used, for example, to prevent closing operating rooms, as the hospital nearly had to do last year.

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Budgets for Ontario's hospitals have essentially been frozen for three years, while the costs of labour and supplies rise.

"I think the profitability of this could be as high as $1-million annually. It could be much more than that, but I think the rate-limiting factor will be the capacity we have to do these cases," he said.

Hospitals in Hamilton, Ont., London, Ont., Montreal, Calgary, Edmonton and Vancouver, contacted by The Globe and Mail said they do not have international patient programs.

The handful of hospitals that do are in Toronto, and say they do not market their services out of the country, even if their international patient programs do a fairly robust business, as UHN's does.

The network of four downtown Toronto hospitals has treated 380 foreign patients since 2011, 81 of whom were Libyans recovering from battlefield injuries brought to Canada through an agreement with Ottawa. Most of the rest came from the Caribbean or the Middle East for cancer and cardiac care.

The program brought in $2.5-million in 2011-2012, $11-million in 2012-2013 and is expected to net $7-million in 2013-2014.

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UHN recently secured malpractice insurance to cover Americans. "We would estimate that including Americans in UHN's International Patient Program would double Program revenues within two years," UHN president Robert Bell wrote in a report to the board of trustees in October.

Yet in an interview, Dr. Bell, who was named last week as the province's deputy minister of health, said the hospital is not trying to drum up business among Americans or other patients from overseas.

"We're not marketing, obviously. Most of these patients come to us through the expertise of our surgeons," he said.

UHN declined to say how much it charges individual international patients.

"Realistically, I'm not going to tell you that. It's a competitive kind of marketplace," Dr. Bell said. "We target being able to provide care for two Ontario patients based on what we're charging for one international payment."

Mount Sinai in Toronto has an agreement with a Bermuda hospital for urgent, high-risk pregnancy cases, which sees between eight and 10 patients per year when capacity is available.

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Toronto's Hospital for Sick Children sees about 200 patients a year who require specialized medical and surgical treatments not available in their own countries. The charitable Herbie Fund covers costs for about 25 of them.

Already swamped with requests from abroad, SickKids does not market its services to raise revenue.

Ontario Health Minister Deb Matthews was unavailable for an interview about medical tourism on Monday. Her spokeswoman said in an e-mailed statement that, "We expect that health care providers, in exploring innovative opportunities, ensure that public funding is used for the purpose for which it has been provided; and, that the hospital conducts its operations in a manner that demonstrates accountability for public funds."

With a report from The Canadian Press

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