Patients without Borders: Medical Tourism in Ontario
March 9, 2015
Patients without Borders: Medical Tourism in Ontario | Tracey Tremayne-Lloyd | LinkedIn Please see my interview on Global TV's "16X9" on March 7th about Medical Tourism. It’s kind of a Jekyll and Hyde thing. On the one hand, medical tourism conjures up images of dubious doctors, illegal organ trade, and seriously “refreshed” women back from a “sea, sun and surgery” trip. On the flip side are top-notch surgeons relieving pain and suffering in a state-of-the-art operating room, one that would have sat dark and empty were it not for international patients who are willing to pay for a procedure out of their own pocket.
Medical tourism is a big business that is poised to grow to gargantuan proportions. According to the website Patients Beyond Borders, there are currently somewhere in the neighbourhood of 11 million cross-border patients in the world. (A cross-border, or international, patient is defined as someone who crosses international borders for the purpose of receiving medical care.) These individuals, and the friends and family, who accompany them, spend in excess of $38 billion dollars in their quest for health care. Patients Beyond Borders estimates market growth in the double-digits with the most significant growth coming from North, Southeast and South Asia. And if things go the way Toronto’s Sunnybrook Hospital hopes they do, some of these people will end up in their facilities.
Sunnybrook came under fire this year when word got out that they were selling medical treatment to foreign patients who had the resources to travel to Canada and pay for their care out-of-pocket. While this isn’t the first Ontario hospital to offer care for cash (the University Health Network (UHN), made up of Toronto General, Toronto Western, Princess Margaret and Toronto Rehab, has treated over 300 foreign patients who have been referred to them since 2011 and both Toronto’s SickKids and Mt. Sanai accept foreign referrals), it is the first to openly promote this line of business. To some, that presents a big problem.
While politicians, health care professionals and the general public alike can accept foreign patients coming to Ontario for treatment on a referral basis, it’s sometimes harder for them to accept a hospital that is actively lobbying for business as Sunnybrook is doing. Those opposed believe that making medical tourism a business line undermines and threatens Canada’s public health care system and they fear Canadians will be bumped in the queue, precious resources will go to foreigners rather than to our citizens, and ultimately, a two-tier system will arise where the rich will have better access to care while the rest of us wait.
Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario, said in a Globe and Mail article, “Medical tourism creates a parallel system. At this point, it’s for people outside the country, but who’s to say tomorrow it won’t be for people inside the country?” Grinspun has warned that if the Ontario government doesn’t order hospitals to stop practicing medical tourism, her union may be compelled to challenge the province in court over the right to pay out-of-pocket for health care.
If It Isn’t Illegal, What’s the Problem?
The issue here isn’t a legal one, it’s political. Sunnybrook and the other Ontario hospitals who accept private payment from foreign patients are not breaking the law so long as no public money is used and Canadians aren’t suffering as a result. The reason this has gained so much attention is that, as Ms. Grinspun points out, the next logical step is to allow Canadians to pay privately for their health care if they so choose and that would spell the end of universal health care in Canada as we know it. The question is, would that be such a bad thing?
Often lost in this discussion is the upside of international patient programs. By allowing our surgeons to practice their craft they become better equipped to help us all. An additional benefit is that medical tourism is lucrative, for all of us. In 2012-2013, the four downtown Toronto hospitals in the University Health Network brought in $11-million in revenue from their international program. Because that money can be used to shore up our woefully underfunded public health care system, rather than reducing the number of resources available to Canadians, medical tourism has the potential to create additional capacity as a portion of the revenue can be used to invest in equipment and prevent hospitals from closing operating rooms due to underfunding, a situation Sunnybrook came close to facing last year. And then there is the spillover into the larger economy as medical tourists also shell out for accommodation, travel, food and entertainment.
Stakeholders will be closely watching Sunnybrook hospital which has so far kept the size of its international program small and has vowed not to displace Ontario patients. While everyone is waiting to see what happens, now might be a good time to have a discussion around how times have changed since universal health care was introduced and what we can and need to do today in order to best deliver health care to Canadians.
Originally published October 7, 2014.