Endless Waiting Lists, Or Medical Free Trade?

Earlier this year, we wrote about the dilemma facing hundreds of thousands of Canadians forced to endure months-long waiting lists for medical care, without which, many would die. This is a devastating prospect in a country that for many decades has prided itself on having a world-class health care delivery system.

But as the waiting lists have grown to over 900,000 nationally, and as the average wait times just for an initial visit with a specialist have stretched to eight weeks, there seems little immediate hope for improvement.

The latest example: according to a recent investigative report in the Toronto Star, the Ontario health ministry has approved $100 million in funding to send 202 people to hospitals in Cleveland, Buffalo, and Detroit to receive allogeneic transplants to treat various cancer and blood disorders they can’t get treated in the province. Allogeneic transplants involve collecting stem cells from matching donors and transplanting them into patients to restore and strengthen their immune systems. Not surprisingly, these are complex, expensive, and debilitating procedures that can take months to complete.

Toronto’s Princess Margaret Cancer Centre—a leading stem cell transplant provider—stopped accepting new patients in March 2016. And two other centres, the Juravinski Hospital in Hamilton and the Ottawa Hospital, can also do the procedures, but they’re at capacity.

As might be expected, critics of the $100-million allocation ask why the money spent on this outsourcing could not be used to shore up Ontario’s system for stem cell transplants. But let’s be honest and practical: a one-time fix among three institutions averages out to just over $30 million each. I hate to say it, but what does $30 million buy in medical technology, labour, and expertise these days? And how long will it last beyond the immediate “fix”?

According to the Toronto Star investigation, Robin McLeod, Cancer Care Ontario’s vice-president of clinical programs and quality initiatives, says that over the last few years funding for stem cell transplants has increased from about $9 million to $19 million. That’s hardly enough to even start a long term, sustainable upgrade in a branch of medicine that is expanding exponentially.

At present, Canada spends more on health care, as a percentage of GDP and per person, than almost any other country—except for five or six. The U.S. spends a great deal more, and Canada spends about as much as Germany, France, the Netherlands, Switzerland, and Sweden. Yet what is spent is clearly not nearly enough to provide diagnostic and therapeutic services sufficient to reduce the growing waiting lists.

Is the answer more money? Or is it a change of thinking?

Canadians have come to think of outsourcing medical care as a negative. It hurts our pride. But Europeans do it routinely. And hundreds of thousands of nationals of many countries are now travelling to centres of excellence in India, Thailand, and Singapore for high quality services they are unable to obtain at home.

There is a case to be made for free trade in medicine: in reality, how many nations can afford to have all medical technologies and expertise available for all people all the time?

If Canada really has hit a wall and can’t afford to provide life-saving medical services in its own facilities, why not redirect resources to developing international referral channels to centres of excellence that can provide the services Canadians deserve? At the very least, it makes sense to send patients to the U.S. for treatment until health care options are sorted out here.

Or do you just keep telling patients that an eight-week wait see a specialist, and ten more weeks* to get medically necessary treatment, is normal? For many, it’s a life or death question.


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