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Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home. A Metroland Special Report shows thousands of others are funding their own medical treatments south of the border, at high personal cost. The numbers have been rising for the last 10 years. Government approvals for out-of-country health care funding are up 450 per cent. Should Ontarians have to use a passport to get health care?
TROY, Mich - At first glance, it looks more like a hotel than a hospital.
Carpeted floors and frosted glass line the hallways. Guests in the waiting room lounge in wingback chairs near a beverage station with complimentary Starbucks coffee.
In all the private rooms, medical equipment is carefully tucked away behind cabinets that look as if they've leapt from the pages of an Ikea catalogue.
Bowls of colourful candy rest within easy reach of smiling nurses and friendly office staff.
Soft jazz is piped through the hallway, where letters stencilled on the wall remind: "The future belongs to those who believe in the beauty of dreams."
This is Unasource - a private day surgery centre in Troy, Mich. It's only 40 kilometres from the Canadian border, but it's a world away from any surgery facility north of the 49th.
"There's a calming effect when you walk into Unasource," said Michael Kuhn of Windsor, who made the trip to Michigan in 2007 to repair a torn tendon in his shoulder. "It's just an absolutely pristine facility."
Kuhn is one of many Canadian patients who found his way to the U.S. for care - a growing group that is fast feeding an industry that emerged in the last decade to help thousands of Canadians find help across the border.
As for just how many are going, it's difficult to say. OHIP paid for 12,000 cases to be treated, diagnosed or tested in American hospitals and clinics last year. But those are only the patients from Ontario who qualified for OHIP pre-approval for a medical ticket south.
"For every one of those, there's probably 10 who say, 'I can't wait,'" said Rick Baker of Timely Medical Alternatives, a B.C.-based medical brokerage, a type of business that's sprung up to fill the gap as wait times put added strain on patients.
For a price they've negotiated in advance with U.S. hospitals, brokers can get you surgery or diagnostics quickly and, they say, cheaper than you might think.
For around ,000, the cost of a mid-size car, you can skip the lines in Ontario and have your knee replaced in Michigan or Colorado with the Windsor-based medical brokerage, International Health Care Providers. The time from the call to their office to specialist appointment to surgical table can be as little as two weeks, said the firm's president, Kelly Meloche.
For about 0, a broker can get you in to a private diagnostic clinic for a MRI in Michigan tonight - and many will even drive you there.
"The world is changing, and saying, 'That free system that we were all so happy to have, well, it was great. But, unfortunately it's not great anymore,' and more and more people, as something happens within the family, are finding that out," said Tracy Bevington, CEO of EcuMedical, another Windsor-based medical brokerage. "As they're finding it out, they're looking for options, and we're here offering those options."
Even though Ontario has taken measures to reduce wait times, the system is still sagging under pressure and generating patient angst.
Need an MRI? The wait is 109 days, according to provincial wait-time figures. As of Nov.1, nearly 140,000 people were on waiting lists for CT and MRI imaging alone.
Centres such as Unasource are more than willing to welcome Canadians looking for expedited care.
The modern rooms, high-tech equipment and plush extras may not surprise choosy American patients. For Ontarians who are focused on faster care, the extras are an added comfort.
At Sky Ridge Medical Centre in Colorado, "we were really designed with a new philosophy in mind that really takes into account a healing environment," said spokesperson Linda Watson.
The Denver-area hospital has recently started booking Canadian patients for orthopedic surgeries.
Every room in Sky Ridge is private, some with panoramic mountain views. Each is equipped with on-demand TV, allowing patients to take in the latest movie or learn more about their condition and treatment.
There's in-room dining with filet mignon and create-your-own omelettes, prepared by chefs.
At Sky Ridge, the wait time for a specialist appointment and joint-replacement surgery is measured in days. In Ontario, where more than 8,500 people are waiting for knee-replacement surgery, 90 per cent of patients will have the surgery within the provincial target of 182 days.
But, that wait only starts after the surgery is scheduled, a process which can add months to the timeline as patients wade through referrals and specialist appointments.
The waits can be agony, and many people look south out of desperation, said Janet Walker, a B.C. nurse who is researching the impact of wait times on patients.
"In Canada, we hear that, yes there are waits, but it's only for elective surgery," she said. "So, we imagine that it's not important and not painful, and that is just not the case."
Brokers, or facilitators as they call themselves, act as a type of medical concierge. Using their own networks of private hospitals and specialists, brokers help clients get diagnostics, treatment and surgery fast.
They'll also help book flights, arrange hotels for longer stays, drive clients across the border - even help find someone to look after pets. Of course, it all comes at a cost.
But often, it's a price Canadians are more than willing to pay if it spares their life or improves their quality of living, said Meloche of International Health Care Providers.
"One of the myths is how it's so incredibly expensive," she said. "The truth is a consultation will cost a couple hundred bucks."
If you go through a broker, that is.
Many brokers can offer clients a discount rate because they negotiate prices with hospitals and specialists in advance. Most get paid by the hospitals where the surgery or treatment takes place.
"We can get a coronary artery bypass, which the usual and customary cost for that is somewhere between ,000 and 0,000. We sent a man (to the U.S.) recently - he paid ,000," said Baker, of Timely Medical Alternatives.
"We've negotiated some deep discounts ... We sent a man from Vancouver for a procedure called angioplasty where they put a stent in the plugged artery. First of all, he called the Mayo Clinic and they wanted ,000. He paid 15 five. He got it in two days."
******
In addition to cost savings, brokers advertise quick and simplified care. EcuMedical of Windsor will pick up clients from the airport, book hotel rooms, ferry them across the border in a company van, and take them directly to the specialist appointment, hospital for surgery or cancer centre for chemo.
Starting from ,000, EcuMedical can arrange for clients to get a new knee, often in about two weeks. That's about 25 per cent less than you'd pay if you tried to price it out directly with the same hospital, said Bevington, the CEO.
While some medical brokers act as advocates for patients within the Canadian system, others such as International Health Care Providers and EcuMedical deal exclusively in the U.S. Bevington said most of his clients pay out-of-pocket because they don't have the time to wait for OHIP approval.
For many clients, it comes down to choosing between an expensive vacation and quality of life. The latter often wins, he said.
"Today's baby boomer isn't like my mom and dad - they want to be active. They don't want to be walking around with a cane or a walker looking like my father and my grandfather did. They want to get out on the golf course. They want to go for a walk. They want to go swimming. So they're saying, 'No, I'm not waiting two years to get my knee replaced, I want to be on the golf course in spring.'"
But for many there is still a stigma attached to the decision to opt out of the queue and take their medical needs stateside.
Others point out the failure of the American system to accommodate the poor and uninsured.
According to the U.S. Census Bureau, 46.3 million Americans were without health insurance in 2008.
Canadians entering into that market could be impeding the access of Americans who require the treatments, said Natalie Mehra, a director of the Ontario Health Coalition - a public interest health care group.
"At the end of the day, the Canadians who go south - whether it be that the government is buying bulk services in U.S. facilities or they're paying on their own - they are very likely jumping the queue in the U.S., because there are so many Americans who won't have the same access to health care as they do," she said. "Where it's unethical, what's sad about that is that people are forced into that position."
******
Many Canadians who've travelled south said they were taken aback by the level of care they received in the U.S. Some describe doctors who took an hour to explain the diagnosis, or others they reached at home on Sunday morning to answer pressing questions. Others say they were stunned by spotless facilities or surprisingly attentive staff.
Walker, the nurse researching the impact of wait times, said that while some patients struggled with initial discomfort over potentially being seen as a queue jumper, not one regretted the decision.
"Every person, every person without exception, said 'I was so glad I went. My treatment was fabulous. The care I got was planets away and better than Canadian care,'" she said.
Brokers say the medical-travel industry is growing, though by exactly how much is difficult to tell.
If the number of brokerages that started up and have grown into successful businesses in the last decade is any measure, the demand is there, and isn't diminishing.
"When we started the business, it started in the Windsor-Essex county area," said Bevington, adding he's been advised not to disclose the number of clients he's assisted. "It's all over Canada now - all of the provinces ... Let us just say this - we used to (schedule) a few scans a week out of my home, and we now have a very large office with a very large staff. It's frequent."
Since his company opened in 2003, Timely Medical Alternatives' Baker said he's helped nearly 2,000 clients. Some he sent to clinics and hospitals in the U.S., others were referred to private medical and diagnostic clinics in Canada.
Meloche, of International Health Care Providers, said she sees about 300 clients a year, and the number is growing.
"It's all going up," she said. "I'm now also getting referrals from physicians themselves. That's a trend really, when you have a Canadian physicians' office calling and saying, 'We've heard about you. What can we know about you because we just need this done. We're not getting it done'."
Meloche said physicians primarily find her through clients who return to their Ontario doctors after surgery.
Most of the doctors are calling out of frustration, Meloche said - they have a patient who needs care quicker than our system can offer.
"Very few (people who go) blame their physician," she said. "They're just saying, 'You know what? I'm just not getting in, and the doctor's now saying that they're doing all they can for me.'"
Brokers say physicians are in a tough spot, but the situation for the average Canadian is only going to worsen, given that so many are without family doctors - the first link in the chain to specialists and diagnostic referrals.
Last year, the Ontario Medical Association estimated about 850,000 people were without a family doctor. Nationwide, Statistics Canada data from the same year estimated that 4.1 million Canadians were without a GP.
Physician shortages are only half the problem, many experts say.
The first of the baby boomers will hit 65 in 2011. In less than 50 years, a quarter of Canadians will be seniors, compared to 13 per cent now.
Health services are about to become a top priority for a group who can afford to pay for their care and demand a better standard of living, brokers point out.
It's a supply-and-demand crisis that can only amount to more people looking for solutions outside the system, Bevington said.
"The need in the next five years for health care is going to dramatically increase on this already-stymied medical situation, and the ability to service it is going to get worse," he said.
"We're heading for the most imperfect storm, and that's real."
Cancer - The Problem and the Solution:
* Discover The Truth About Cancer And How To Eliminate Sickness And Disease Naturally. More details
* Cancer: From Diagnosis To All Clear In 11 Months. More details
* Treating Prostate Cancer Naturally. More details
Record numbers of Ontarians are being sent to the U.S. by their government for routine health care that should be available at home. A Metroland Special Report shows thousands of others are funding their own medical treatments south of the border, at high personal cost. The numbers have been rising for the last 10 years. Government approvals for out-of-country health care funding are up 450 per cent. Should Ontarians have to use a passport to get health care?
TROY, Mich - At first glance, it looks more like a hotel than a hospital.
Carpeted floors and frosted glass line the hallways. Guests in the waiting room lounge in wingback chairs near a beverage station with complimentary Starbucks coffee.
In all the private rooms, medical equipment is carefully tucked away behind cabinets that look as if they've leapt from the pages of an Ikea catalogue.
Bowls of colourful candy rest within easy reach of smiling nurses and friendly office staff.
Soft jazz is piped through the hallway, where letters stencilled on the wall remind: "The future belongs to those who believe in the beauty of dreams."
This is Unasource - a private day surgery centre in Troy, Mich. It's only 40 kilometres from the Canadian border, but it's a world away from any surgery facility north of the 49th.
"There's a calming effect when you walk into Unasource," said Michael Kuhn of Windsor, who made the trip to Michigan in 2007 to repair a torn tendon in his shoulder. "It's just an absolutely pristine facility."
Kuhn is one of many Canadian patients who found his way to the U.S. for care - a growing group that is fast feeding an industry that emerged in the last decade to help thousands of Canadians find help across the border.
As for just how many are going, it's difficult to say. OHIP paid for 12,000 cases to be treated, diagnosed or tested in American hospitals and clinics last year. But those are only the patients from Ontario who qualified for OHIP pre-approval for a medical ticket south.
"For every one of those, there's probably 10 who say, 'I can't wait,'" said Rick Baker of Timely Medical Alternatives, a B.C.-based medical brokerage, a type of business that's sprung up to fill the gap as wait times put added strain on patients.
For a price they've negotiated in advance with U.S. hospitals, brokers can get you surgery or diagnostics quickly and, they say, cheaper than you might think.
For around ,000, the cost of a mid-size car, you can skip the lines in Ontario and have your knee replaced in Michigan or Colorado with the Windsor-based medical brokerage, International Health Care Providers. The time from the call to their office to specialist appointment to surgical table can be as little as two weeks, said the firm's president, Kelly Meloche.
For about 0, a broker can get you in to a private diagnostic clinic for a MRI in Michigan tonight - and many will even drive you there.
"The world is changing, and saying, 'That free system that we were all so happy to have, well, it was great. But, unfortunately it's not great anymore,' and more and more people, as something happens within the family, are finding that out," said Tracy Bevington, CEO of EcuMedical, another Windsor-based medical brokerage. "As they're finding it out, they're looking for options, and we're here offering those options."
Even though Ontario has taken measures to reduce wait times, the system is still sagging under pressure and generating patient angst.
Need an MRI? The wait is 109 days, according to provincial wait-time figures. As of Nov.1, nearly 140,000 people were on waiting lists for CT and MRI imaging alone.
Centres such as Unasource are more than willing to welcome Canadians looking for expedited care.
The modern rooms, high-tech equipment and plush extras may not surprise choosy American patients. For Ontarians who are focused on faster care, the extras are an added comfort.
At Sky Ridge Medical Centre in Colorado, "we were really designed with a new philosophy in mind that really takes into account a healing environment," said spokesperson Linda Watson.
The Denver-area hospital has recently started booking Canadian patients for orthopedic surgeries.
Every room in Sky Ridge is private, some with panoramic mountain views. Each is equipped with on-demand TV, allowing patients to take in the latest movie or learn more about their condition and treatment.
There's in-room dining with filet mignon and create-your-own omelettes, prepared by chefs.
At Sky Ridge, the wait time for a specialist appointment and joint-replacement surgery is measured in days. In Ontario, where more than 8,500 people are waiting for knee-replacement surgery, 90 per cent of patients will have the surgery within the provincial target of 182 days.
But, that wait only starts after the surgery is scheduled, a process which can add months to the timeline as patients wade through referrals and specialist appointments.
The waits can be agony, and many people look south out of desperation, said Janet Walker, a B.C. nurse who is researching the impact of wait times on patients.
"In Canada, we hear that, yes there are waits, but it's only for elective surgery," she said. "So, we imagine that it's not important and not painful, and that is just not the case."
Brokers, or facilitators as they call themselves, act as a type of medical concierge. Using their own networks of private hospitals and specialists, brokers help clients get diagnostics, treatment and surgery fast.
They'll also help book flights, arrange hotels for longer stays, drive clients across the border - even help find someone to look after pets. Of course, it all comes at a cost.
But often, it's a price Canadians are more than willing to pay if it spares their life or improves their quality of living, said Meloche of International Health Care Providers.
"One of the myths is how it's so incredibly expensive," she said. "The truth is a consultation will cost a couple hundred bucks."
If you go through a broker, that is.
Many brokers can offer clients a discount rate because they negotiate prices with hospitals and specialists in advance. Most get paid by the hospitals where the surgery or treatment takes place.
"We can get a coronary artery bypass, which the usual and customary cost for that is somewhere between ,000 and 0,000. We sent a man (to the U.S.) recently - he paid ,000," said Baker, of Timely Medical Alternatives.
"We've negotiated some deep discounts ... We sent a man from Vancouver for a procedure called angioplasty where they put a stent in the plugged artery. First of all, he called the Mayo Clinic and they wanted ,000. He paid 15 five. He got it in two days."
******
In addition to cost savings, brokers advertise quick and simplified care. EcuMedical of Windsor will pick up clients from the airport, book hotel rooms, ferry them across the border in a company van, and take them directly to the specialist appointment, hospital for surgery or cancer centre for chemo.
Starting from ,000, EcuMedical can arrange for clients to get a new knee, often in about two weeks. That's about 25 per cent less than you'd pay if you tried to price it out directly with the same hospital, said Bevington, the CEO.
While some medical brokers act as advocates for patients within the Canadian system, others such as International Health Care Providers and EcuMedical deal exclusively in the U.S. Bevington said most of his clients pay out-of-pocket because they don't have the time to wait for OHIP approval.
For many clients, it comes down to choosing between an expensive vacation and quality of life. The latter often wins, he said.
"Today's baby boomer isn't like my mom and dad - they want to be active. They don't want to be walking around with a cane or a walker looking like my father and my grandfather did. They want to get out on the golf course. They want to go for a walk. They want to go swimming. So they're saying, 'No, I'm not waiting two years to get my knee replaced, I want to be on the golf course in spring.'"
But for many there is still a stigma attached to the decision to opt out of the queue and take their medical needs stateside.
Others point out the failure of the American system to accommodate the poor and uninsured.
According to the U.S. Census Bureau, 46.3 million Americans were without health insurance in 2008.
Canadians entering into that market could be impeding the access of Americans who require the treatments, said Natalie Mehra, a director of the Ontario Health Coalition - a public interest health care group.
"At the end of the day, the Canadians who go south - whether it be that the government is buying bulk services in U.S. facilities or they're paying on their own - they are very likely jumping the queue in the U.S., because there are so many Americans who won't have the same access to health care as they do," she said. "Where it's unethical, what's sad about that is that people are forced into that position."
******
Many Canadians who've travelled south said they were taken aback by the level of care they received in the U.S. Some describe doctors who took an hour to explain the diagnosis, or others they reached at home on Sunday morning to answer pressing questions. Others say they were stunned by spotless facilities or surprisingly attentive staff.
Walker, the nurse researching the impact of wait times, said that while some patients struggled with initial discomfort over potentially being seen as a queue jumper, not one regretted the decision.
"Every person, every person without exception, said 'I was so glad I went. My treatment was fabulous. The care I got was planets away and better than Canadian care,'" she said.
Brokers say the medical-travel industry is growing, though by exactly how much is difficult to tell.
If the number of brokerages that started up and have grown into successful businesses in the last decade is any measure, the demand is there, and isn't diminishing.
"When we started the business, it started in the Windsor-Essex county area," said Bevington, adding he's been advised not to disclose the number of clients he's assisted. "It's all over Canada now - all of the provinces ... Let us just say this - we used to (schedule) a few scans a week out of my home, and we now have a very large office with a very large staff. It's frequent."
Since his company opened in 2003, Timely Medical Alternatives' Baker said he's helped nearly 2,000 clients. Some he sent to clinics and hospitals in the U.S., others were referred to private medical and diagnostic clinics in Canada.
Meloche, of International Health Care Providers, said she sees about 300 clients a year, and the number is growing.
"It's all going up," she said. "I'm now also getting referrals from physicians themselves. That's a trend really, when you have a Canadian physicians' office calling and saying, 'We've heard about you. What can we know about you because we just need this done. We're not getting it done'."
Meloche said physicians primarily find her through clients who return to their Ontario doctors after surgery.
Most of the doctors are calling out of frustration, Meloche said - they have a patient who needs care quicker than our system can offer.
"Very few (people who go) blame their physician," she said. "They're just saying, 'You know what? I'm just not getting in, and the doctor's now saying that they're doing all they can for me.'"
Brokers say physicians are in a tough spot, but the situation for the average Canadian is only going to worsen, given that so many are without family doctors - the first link in the chain to specialists and diagnostic referrals.
Last year, the Ontario Medical Association estimated about 850,000 people were without a family doctor. Nationwide, Statistics Canada data from the same year estimated that 4.1 million Canadians were without a GP.
Physician shortages are only half the problem, many experts say.
The first of the baby boomers will hit 65 in 2011. In less than 50 years, a quarter of Canadians will be seniors, compared to 13 per cent now.
Health services are about to become a top priority for a group who can afford to pay for their care and demand a better standard of living, brokers point out.
It's a supply-and-demand crisis that can only amount to more people looking for solutions outside the system, Bevington said.
"The need in the next five years for health care is going to dramatically increase on this already-stymied medical situation, and the ability to service it is going to get worse," he said.
"We're heading for the most imperfect storm, and that's real."
Cancer - The Problem and the Solution:
* Discover The Truth About Cancer And How To Eliminate Sickness And Disease Naturally. More details
* Cancer: From Diagnosis To All Clear In 11 Months. More details
* Treating Prostate Cancer Naturally. More details
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