Colleen Flood is an expert advisor with EvidenceNetwork.ca and a Professor in the Faculty of Law, the School of Public Policy & Governance, and the Institute of Health Services Management & Evaluation University of Toronto.
So it looks like the 'magic bullet' solution has been found at last to cure Canada's health care woes: medical tourism. Last week, Toronto's Sunnybrook hospital defended its position to court affluent medical patients from other countries who can afford to pay generously for out-of-pocket care in a Canadian hospital. It's a revenue-generating solution for a cash-strapped system, we are told. A handful of other hospitals already engage in this practice, and many across the country are starting to sit up and take notice. Should we break out the champagne and celebrate?
Not so fast. Medical tourism looks at first like a cash cow but it is more like a many-headed Hydra.
Proposals by public hospitals to sell care to medical tourists to expand their revenue base are understandable given tough economic times. But experience from other countries suggests that promises of revenue flow-back to the public system do not always eventuate. How will we know that profits made off the backs of wealthy (and/or desperate) medical tourists from other countries are actually reinvested with the needs of Canadian patients in mind – as opposed to, for example, higher payments for the surgeons providing the care?
And even if there is some reinvestment back that measurably benefits public patients this has to be traded off against the fact that beds for medical tourists are clearly beds that could be used – right now – by Canadians. If these beds are going spare when people are currently lined up in crowded emergency rooms from coast to coast, then something is clearly amiss. Moreover, basic market principles dictate that the higher prices that can be charged to privately paying medical tourists will divert at least some physicians from treating public patients. If the private sector pays more, and medical tourism is lucrative, then it strains credibility to suggest that doctors will not be further tempted into that sector.
If medical tourism is the solution, we'd best ask first, what's the problem? Many Canadians might suggest wait times. This is a legitimate concern. Too many of us wait too long for the care we need and deserve. Across the country there are calls (and court cases being brought) to privatize as a solution to remedy wait times. But it is a solution only for those who can afford to pay. We know from initiatives in other countries and from the example of cardiac care in Ontario, and with orthopedic surgery in Alberta, that we can fix wait times for all Canadians within the public system. And it doesn't necessarily mean we need to spend more.
More cash in the health care system is not necessarily what we need. From a global perspective, we put an awful lot of public money in – but those who spend it on our behalf are not getting value for our money. In other words, we are paying too much for drugs that frequently don't do very much, too much to some providers and not enough for others, and we are not rationally allocating our resources to achieve a bigger bang for our health care buck.
With respect to wait times, research tells us that we won't solve this problem with more private dollars but we can solve this problem by having all patients referred for surgery into a central triaged system. This will ensure that a patient is sent to the first available specialist and not the one that his or her family doctor happens to have on speed dial, and that the system (and not a doctor's secretary) is responsible for making sure care is secured in a timely way for each and every patient.
Why, when we have proven solutions that could be used to reduce wait times, are the people who run our system not focused on implementing solutions? Canadians have been acclimatized to an increasing level of mediocrity in medicare and cowed from demanding more by the constant refrain of how much health care costs. We should not be so reticent in demanding more from those who run our health care system.
In the final analysis, if government, hospitals and physicians can promise excellent and timely care to tourists from other countries there is no reason why the same promise can't be made to all Canadians – and we should demand it of them.