This is the nonsense that defenders of our Canadian public healthcare system continuously spout. Those with a stake in maintaining the status quo (primarily healthcare unions) are terrified of the possibility of a parallel, private (and non-unionized) healthcare system.

We have a client who has requested a copy of the printout of an ECG, from the hospital where the procedure was done.

It would take less than 60 seconds for a clerk to find this information and fax it to our client. Instead, she was told “our standard practice is to respond to these requests within 6 weeks”. 6 weeks to perform a 60 second task!

Timely Medical Alternatives operates in the private sector (to the annoyance of the Canadian Healthcare coalition (read “healthcare unions”). Our standard practice is to respond to requests for information within 24 hours.

So, the public healthcare system responds in 6 weeks. The private healthcare sector responds in 24 hours.

Tell us again, which system is most efficient?

We hear this comment all the time. Sadly, in our socialized healthcare system, in Canada, compassion generally takes a backseat to maintaining the bureaucratic status-quo.

We get calls from Canadians who have been suffering, often in severe, immobilizing pain, for years.  And nobody will take the time to listen to them, to hear about their condition. And so they wait, and wait, and wait.

Most Canadians simply have no idea how poorly we are served by our healthcare system, until they need access to it themselves. We are working with a woman in Ontario who has a prolapsed bowel and bladder.  She has been in pain since October of last year. She has been “promised” a surgical date “sometime in April”.  In the meantime, she is bleeding constantly.

Contrast this with another client of ours who needs arthroscopic knee surgery and is on a long waiting list. “Why cant he get his surgery in the public healthcare system, right away?” asked his wife. “Don’t they understand that he is in pain?” “Why won’t they listen to him?”.

Her husband and the woman in Ontario, are just two of the estimated 750,000 Canadians on lengthy medical waiting lists.

Recently, we arranged a very complex gynecological/urological surgery for an elderly client from Alberta. While her expression of appreciation was nice to hear, something else she said particularly resonated with us.

She said “I have been trying for years to get this surgery, without success. The surgeons to whom you referred me (in the U.S.), are the first who really listened to me; the first who seemed to care”.

We aren’t suggesting that Canadian healthcare providers don’ have compassion for their patients. But a surgeon with 200 patients on his waiting list, may not always have the luxury of being able to spend the amount of time he or she might otherwise like, to have to listen carefully to the suffering patient.

A man contacted us yesterday, seeking a hospital where his wife could get a robotically assisted Mitral Valve Repair.

His Preference was for a hospital in the U.S. northeast. Boston perhaps, or maybe the Cleveland Clinic.

We explained that the cost of this type of surgery varies widely, from $27,000 (which is what our clients pay at a superb specialty heart hospital in the mid west), up to $150,000 (for the identical procedure) at some other, more well known hospitals. We explained further, that our criteria for hospitals iwshing to join our network of providers, is:

• hospitals must provide top quality care
• hospitals must charge reasonable rates

The only hospitals meeting both these criteria, are in the mid-western United States.

The gentleman persisted. “But I don’t want to go anywhere outside of the Northeast” (where the rates charged at the top end of the scale).

We were unable to help him.

A new study “Medical Tourism Services Available to Residents of the United States” published in the Journal of General Internal Medicine casts doubts on many of the claims made about the size of the medical tourism market and concludes that “the number of Americans travelling overseas for medical care with assistance from medical tourism companies is relatively small”.

Published in December’s issue of the Journal of General Internal Medicine, “Medical Tourism Services Available to Residents of the United States” is a report on the businesses and business practices of companies promoting and facilitating medical tourism to US patients and the types and costs of procedures being offered. In late 2008, the researchers conducted a telephone and email survey of businesses engaged in facilitating overseas medical travel for US residents. They collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. 63 medical tourism companies were selected for inclusion and 45 (71%) completed the survey.

13,500 US medical tourists from 45 businesses since start up

The 45 companies involved had referred an average of 285 patients overseas since start up (not in the previous twelve months).  The survey recorded a total of approximately 13,500 US medical tourists in total for all 45 businesses since they started in business. The most common overseas countries that companies reported referring patients to were India, Costa Rica, and Thailand though many other countries were mentioned less frequently including Malta, Israel, Spain and Germany. The most common medical services utilized by overseas medical travelers were orthopedic procedures, cardiac procedures, infertility treatment, and cosmetic surgery. (The study specifically excluded companies that focused exclusively on dental care).

The authors highlight the significant difference between their grand total of 13,500 US medical tourists travelling via 45 medical travel facilitators and the “number of articles, studies, and reports (that) have suggested that between 500,000 and 2,000,000 Americans travel overseas each year for medical care.” They believe that their study mirrors and supports the kind of numbers quoted by McKinsey & Co (Mapping the Market for Medical Travel) who estimated “the current market at 60,000 to 85,000 inpatient medical travelers a year—numbers far smaller than others have reported.”

The study authors propose that the discrepancy in the estimates of the size of the overseas medical market is related to the following factors:

1.       Estimates of a much larger US medical tourism market were proposed by parties with personal and/or financial interests in the overseas medical travel market.

2.       Their study did not attempt to measure the number of Americans travelling for dental care. This is believed to be quite a high proportion of the US outbound market, particularly cross border to Mexico and to South America. According to Sandra Miller at Health Travel Technologies, “We process more than 600 inquiries per months, and send more than 100 patients a month abroad……..We send 20 dental patients per month to top notch dental clinics in Mexico, Costa Rica, the Dominican Republic and El Salvador.”

3.        Their study did not attempt to measure the number of Americans who may have traveled overseas without using the services of a medical tourism facilitator. Estimates of how many medical tourists use a facilitator vary widely. Some US estimates put this as low as one in five patients who use the services of a facilitator.  (Research on UK medical tourists put this figure as around one in three – Treatment Abroad Medical Tourism Survey 2008).

The authors point out that even when items 2 and 3 above are factored in, “the market may be somewhat smaller than prior studies have estimated”. They also point out that two years after conducting the interviews, they found that 15.6% (7 of 45) of companies that completed the initial interviews no longer had functioning websites and thus were presumed to no longer be in business.

It’s also worth pointing out that the survey was restricted to medical tourism facilitators who had a US phone number. 97 facilitators were excluded from the research for this reason. This in effect excludes many Mexican, South American and Asia based facilitators who handle US patients.

Cost savings for medical travel less than claimed

The study’s findings related to the cost of overseas medical travel also warrant mention. The authors report that “overseas medical costs for several procedures were generally similar to combined hospital and physician payments made by Medicare for the same procedures.” For example, according to the study, a heart bypass surgery costs an average of $18,600 outside the USA. Within the USA, Medicare pays around $21,000 for the procedure. They conclude that “the take-away message is that the expected savings from overseas medical care is dependent on what, typically uninsured, patients might be expected to pay if they instead purchased this care in the US” and “the fact that overseas charges are reasonably close to Medicare rates suggests that there may be significant opportunity for US providers to compete with offshore facilities, in some situations, by offering highly discounted prices to uninsured American patients.”

IMTJ comment

We welcome this attempt to put some validity on the size of the US outbound market. The study is one of the first to approach the thorny issue of US medical tourism statistics by asking medical tourism businesses how many patients they actually handle rather than by creating “guesstimates” based on what people say they might do. It also puts some of the oft quoted predictions of “6 million US medical tourists in 2010, 10 million by 2012” etc etc in a different light.

A similar approach was adopted in 2007 in a study by Treatment Abroad in which facilitators, hospitals and clinics were asked to provide numbers of UK patients treated. This study put the number of outbound UK medical tourists at around 50,000 (similar to numbers recorded in the UK’s International Passenger Survey data.)

However, the new study does have its flaws – sampling bias, exclusion of dental care, exclusion of self arranged medical travel – which undoubtedly impacts the overall number of medical tourists that it counts. Nevertheless, even if we allow for these flaws and factor in the “missing” patients, the study suggests that the annual outbound medical tourism patient numbers for the USA are perhaps in the region of 100,000 to 200,000 at best, rather than the millions that have been mooted elsewhere.

The study highlights the areas of healthcare that are driving US medical travel – cosmetic (and obesity) surgery, stem cell treatment, IVF treatment, cosmetic dentistry and other non-insured areas which will not be covered by “Obamacare”. It does not analyse the clear ethnic trend in medical travel in the USA and elsewhere  – people who are travelling from the country of residence to their own, their father’s or their grandfather’s nation of birth. This is a significant driver of US medical travel:  Mexicans to Mexico, Hispanics to Latin and South America, Asians to Asian countries, Koreans to Korea etc.

Although, they are now in effect two years out of date, the findings of “Medical Tourism Services Available to Residents of the United States” reflect what many people within the industry believe is closer to the truth in terms of medical tourism patient numbers. i.e. thousands not millions.  Many countries, their governments and hospital providers have come to believe that the US market represents a rich source of patients but have been disappointed by their lack of success. They may need to revise their expectations and rethink their strategy.

Elsewhere on our site, is a recent report from the Fraser Institute, wherein they state that the waiting lists for medical care in Canada are over twice the length as in 1993, and now the longest in Canada’s history.

Apart from the inconvenience and pain of waiting for urgently needed surgery, the waits now exceed the maximum allowable times set by surgeons. The following letter from a client we sent to Arizona for repairs to his shoulder, illustrate the dangers of long waits. Wait lists for shoulder surgery in Canada often exceed 1 year

Christian:

Further to our numerous emails, I had the surgery and all seems to be going well.  Recovery is slow, but that is to be expected. The surgeon was quite surprised at the extent of the shoulder damage when he went it – from a tear the size of a dime to one the size of a silver dollar was his description.  He noted that had I waited a year to get the surgery, he would not have done it because the damage would have been too far gone! It was a great experience from a customer service point of view.

All appointments were scheduled at my convenience.  During my stay in Phoenix for 2 ½ weeks, I met with the surgeon 3 times aside from the surgery itself.  My wife met with him once while I was in post surgery.  They kept me overnight because my stomach didn’t take well to the pain medication.  Really nice private hospital – great service – smiling faces on the staff!!  It was amazing when compared to the public system here.  – I would highly recommend!!!

There are tens of thousands of hospitals, all across the U.S.  In every state, every city, and in most towns.  We have agreements with 22 of these hospitals. Depending on the surgical procedure required, we may refer a particular client to a facility hundreds, or even thousands, of miles from his or her home. Clients are often puzzled as to why we don’t have facilities closer to their home.  Here are some of the reasons:

1. Many U.S. states simply do not have any reasonably priced facilities at all. States like Massachusetts, Alaska, Hawaii, Virginia, New York, Pennsylvania, Florida, Michigan, Washington, Oregon, & California, charge outrageous prices. Examples: a cardiac procedure called “ablation” which costs clients of ours $13,000 in Kansas, costs $50,000 in Washington. A cardiac bypass which costs our clients $16,000 in Oklahoma, costs over $100,000 in California. An elbow replacement which costs our client’s $40,000 at one of the top orthopedic hospitals in the entire U.S., costs $165,000 in Pittsburg. Clearly, it is worth driving or flying to a distant state to save this kind of money.
2. All of our network hospitals are highly rated for performing the type of surgeries that we send to them. Everyone knows about hospital such as Cleveland Clinic, Mayo Clinic, & Johns Hopkins. There is no question about their capabilities. But there are hundreds of U.S. hospitals with comparable quality ratings. Those are the type of hospitals with whom we deal.
3. We do not deal with hospitals with multiple levels of middle management. We get price quotes from the hospitals in our network within days, often within minutes. Many other hospitals are simply unable or are unwilling to provide quotations in advance of a surgery. If they do provide quotes, sometimes we would have to wait 4-6 weeks(!) for a price quotes. We no longer deal with these hospitals

In summary, to join our network of providers, a hospital needs to respond to our inquiries promptly, provide us with deeply discounted pricing, and provide top quality surgeries.

So far, we have found 22 such hospitals in the U.S.

Rick & Christian Baker recently made a trip down to Oklahoma to visit a number of the facilities to which they refer their Canadian clientele. During that trip, the Oklahoman – the largest newspaper in the state – heard about their visit and ran a piece on them, and how they send Canadians who are suffering on long waiting lists, down to Oklahoma for fast exceptional, care.  The article can be viewed here.

In May of 2011, we referred a client from Ontario, to a hospital in the U.S., where we have negotiated favorable pricing. He required replacement for both of his shoulders.
The first replacement was done at that time. Our client reported that his pain went from a “10 to a 0” within 24 hours.
This client’s second shoulder replacement is scheduled, at the same U.S. hospital, in early September.
In the meantime, our client recently got a call from a Canadian shoulder surgeon, setting up a consultation, leading up to replacement of his left shoulder. At the appointment, he explained to the surgeon that his left shoulder had already been replaced, but he now requires the replacement of the other shoulder. The surgeon explained that they would have to fill out reams of paperwork in order to switch from replacing the left shoulder, to now replacing the right shoulder.
“Couldn’t we just cross out the adjective ‘left’, wherever it appears, and replace it with ‘right’”, enquired our client. “No” was the reply.
Once the new paperwork was completed, our client had a follow-up meeting with the Canadian surgeon. Many of our client’s questions went unanswered.
The questions were reasonable and appropriate – after all, the client knew intimately what to expect from a shoulder replacement procedure. But answers were not forthcoming.
To make a long story short, our client has decided to forego getting the second shoulder replaced in Canada, and will be going to the U.S. in September instead.  To put this decision in perspective, the surgery in Canada would have been “free”. The second surgery in the U.S., will cost our client over $20,000, even after the courtesy discount we are offering him.
We asked our client why he would do this. His answer made perfect sense. When he returned to Ontario after his first shoulder replacement, he went to a physiotherapist. The therapist was stunned at how much range of motion he had recovered in such a short time. She had never seen a client who recovered so quickly and completely.
Our client told us “I sympathize with Canadians who are stuck on long medical waiting lists and who don’t have the financial resources to take charge of their own healthcare and to go to the U.S. for immediate care”.  He went on to say, “but there is more than timing at issue here. Put simply, I have more confidence in my U.S. surgeon than in my Canadian surgeon” he stated. “Happily, I have the funds to get, what is in my opinion, a better surgical experience” he concluded.
We couldn’t have put it better ourselves.

An article in the June 28th edition of the “Vancouver Sun”, reported that a Vancouver Island man, suffering from inoperable chronic back pain, has received relief in the form of an implanted neuro-stimulator.

He is one of (reportedly) 13 BC residents who are fortunate enough to get such a device in any given year.

There are, reportedly, 900,000 BC residents with the same chronic pain condition, who are on teh waiting list for one of these devices.  By our calculations, at 13 implants per year, the waiting list is 692,307 years long!

We recently facilitated a private pay neuro-stimulator implant for a BC resident who couldn’t wait that long.  His life is now back on track.