Social Policy in Ontario

Ontario’s Liberal government has long styled itself the champion of public medicare. In some ways it is.

But its quiet decision to let public hospitals offer medical services to well-heeled foreigners threatens to erode the very system that the Liberals say they are trying to bolster.

The latest public hospital to embrace medical tourism as a money-making venture is Sunnybrook Health Sciences Centre. Health Minister Deb Matthews confirmed Tuesday that the Toronto institution is embarking on a plan to actively court foreign patients and charge them hefty treatment fees.

In an interview, she said that Sunnybrook doctors involved in treating foreign medical tourists wouldn’t be paid the rate set by OHIP, the provincial medicare plan, but would receive “negotiated fees.”

She said the hospital has pledged to sink any net profits from the scheme into expanding “care for Ontarians.”

Matthews told me that, in Ontario, public hospitals can decide unilaterally whether to enter the medical tourism business. Government approval is not required.

Other provinces, most notably Quebec, don’t take such a hands-off approach.

Matthews said that Sunnybrook did “let us know how it is going to protect Ontario patients.”

The Globe and Mail, which first broke the Sunnybrook story, said the hospital’s initial plan is to accept no more than 10 foreign patients in the first year.

While Sunnybrook may be pursuing foreign patients more aggressively than most, it is not the first Ontario hospital to service medical tourists.

Toronto’s University Health Network, which includes Toronto General and Princess Margaret Hospitals, set out to formalize its international business four years ago — with the active encouragement of the Liberal government.

That was around the time that then economic development minister Sandra Pupatello led a delegation of hospital executives to the Middle East, specifically to pitch Ontario health services.

The University Health Network ended up signing a consulting contract with Kuwait that has been worth $30 million over the last three years, said vice- president Gillian Howard. Over the same period, its member hospitals also earned $20.5 million from treating 380 foreign patients.

Howard said her hospitals don’t seek out international patients and usually get more requests for treatment than they can handle.

Doctors are paid the OHIP rate plus “a small premium.” Like Sunnybrook, the University Health Network says it plows any profits back into member hospitals.

So what’s the problem?

The first has to do with resources. There are only a finite number of physicians, nurses and hospital beds in Ontario. A top heart specialist performing surgery on well-to-do foreigners is, by definition, not available at that moment to treat Ontarians.

The hospitals answer that they can use medical tourism funds to keep operating rooms open longer and thus reduce wait times for Ontarians. But this in turn, underscores the real problems of the health-care system — the fact that governments, both federal and provincial, are cutting back funds.

It may be true that just throwing money at the health-care system won’t fix it. But it is also true that Canada’s public health-care system can’t work without sufficient funds.

If this money comes from the public, the system will respond to public needs. But if it comes from wealthy foreigners, the system will respond to their needs. This is how things work. It is a fact of life.

The second grave problem is political. Medicare is based on the notion that access is determined by need rather than wealth, that the sickest are treated first.

Medical tourism turns this principle on its head. Access goes to those willing to pay.

And if rich foreigners are allowed first-class treatment by paying out of pocket, why can’t well-to-do Ontarians receive the same privilege?

Matthews vowed that this will never happen under her watch.

“It’s absolutely not on for Ontarians to move to the front of the line,” she told me. “I spend every minute of every day protecting universal health care.”

Perhaps. But by allowing medical tourism, she is opening the door to two-tier health care. She is nibbling away at the heart of what she claims to protect.

< http://www.thestar.com/news/canada/2014/04/03/why_ontarios_medical_tourism_threatens_medicare_walkom.html >