Sunday, February 1, 2009

Brian Day gives new meaning to doctors without borders

Medical tourism is the new hope for the North American economy and the health care systems of the United States and Canada. Skeptical? Just listen to Dr. Brian Day, whose proposal was published on January 26 in the National Post. Day suggests that once Canada has taken care of Canadians who are waiting for operations, it would then do the same for the world. More specifically, he seems to covet the business of US citizens stymied by the lack of affordable treatment in their country.

With 47 million un- or underinsured people in the United States, Day sees a huge untapped market. Why fly to Asia or drive down to a dodgy hospital in Mexico? Just come to Vancouver, Toronto, or Montreal for excellent care at 60 to 90 percent the cost of treatment at home. He also suggests that US insurance companies would gleefully buy discounted treatment from their friendly northern neighbour.

How he arrived at the discount figures is unclear, but it’s well known that administrative costs are much lower in Canada because of the single-payer system. Canadian doctors are also paid less than US doctors, at least in the publicly funded insurance scheme. Although he suggests that public hospitals in Canada would participate in this industry, that seems unrealistic. Would the lower costs hold in a commercialized, for-profit Canadian context? Unlikely. Day, in fact, has vigorously promoted activity-based funding, which may increase the administrative burden in clinical settings and fuel inflation.

The suggestion that developing Canada as a “medical tourism” destination would benefit US citizens is absurd. It would benefit medical entrepreneurs like Brian Day, but taking patients away from home and family, or bringing family along, would be costly and stressful. Those costs would be borne by individuals. Furthermore, this model would perpetuate the bad habits of US health insurance companies, which are always seeking to shift costs and maximize profits. And it would provide further rationale to avoid meaningful health-care reform in the United States.

Day argues that the costs borne by Canadian citizens who are disabled while waiting for imaging or surgery are unacceptable. With that, all can agree. The solution, however, is a well-organized, universal, fully resourced, publicly funded health care system, and Canada is not there yet. Adding a for-profit tier is a false solution.

Because of the transborder health-care asymmetry, a US health-care entrepreneur is suing Canada to enter the market here, but nothing stops Brian Day from establishing clinics within the United States. Maybe he’s too busy with his own lawsuit. He and the organization he helps lead, the Canadian Independent Medical Clinics Association, have initiated legal action to force British Columbia to allow commercial insurance for medically necessary care. If successful, this would bring the Canadian Supreme Court’s Chaoulli decision into force in BC.--Randall F. White

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