This morning, numerous health organizations across Ontario called on the provincial government to ban medical tourism. Medical tourism is the practice where health-care institutions create for-profit programs to attract patients from other countries to come to Canada for health care on a pay-for-treatment basis.
In Ontario, it has come to light that several Toronto area hospitals (around 10 hospitals including Sunnybrook & University Health Network) are actively engaging in medical tourism and that the government is allowing them to continue unobstructed. Other medical mercenaries, like Windsor Regional Hospital are remaining opaque on the details of the partnership they are exploring with Detroit’s Henry Ford Hospital and how it plans to expand procedures to"‘others" (i.e. paying medical tourists).
The RNAOs chief executive officer, Dorris Grinspun, stated today that, “We have raised this issue with Premier Kathleen Wynne and with Deb Matthews (former health minister) and Eric Hoskins (current health minister) numerous times, and although they are aware of our concerns, they are not doing enough to stop this practice in its tracks."
There are a lot of red herrings and deceptions around the issue of medical tourism coming from the provincial government. It is important look at the facts of the matter in order to outline why this practice is both fundamentally uninformed and a major threat to the universality of our health care.
- Let’s be clear, medical tourism isn’t about empathy, it’s a business venture being smuggled into our public health care system. There is a major difference between humanitarian care (the sharing of Canada’s health expertise and providing humanitarian service to patients in need) and what we are seeing. Further, all Canadian hospitals treat foreign patients in emergencies, inviting overseas patients to apply for care on hospital websites is something all together different. Medical tourism is about queue jumping by the rich from around the world based on how much they can pay.
- One of the core principles of Canada’s Medicare is that everyone receives health care based on their need and not their ability to pay. To jump to the front of the line over patients with real medical needs (wherever they are coming from) is antithetical to what Canadians say they value -- in poll after poll -- as a fundamental feature of our equitable system. Access to health care is a human right and public good; the commodification of illness and profiteering from human suffering -- by permitting preferential hospital services based on ability to pay in our system -- is reprehensible.
- We hear a lot about wait times and hospital resources. Medical tourism’s "pocketbook health care" diverts resources that should be available to Ontario residents. As far as most health experts are concerned, there is no surplus of nurses, doctors or other health professionals in Ontario. If there are open beds or health practitioners with time on their hands, I’m sure you don’t need to look to the Middle East, China, or the Caribbean for patients. This idea that there is "unused capacity" in hospitals is simply not true -- and if it were, why aren’t governments working together to ensure better use of these resources to reduce waiting times for Canadians who fund public medical services? To compound the matter -- already there have been reports heard of locals being bumped for patients from abroad in this medical tourism experiment. As a recent letter to the Minster of Health pointed out, "If hospitals believe they have such a surplus, this unused capacity should be put toward shortening wait times for Ontarians, who ultimately keep the system running through their taxes." Despite claims of zero public dollars being spent, medical tourism will only push Ontarians lower on waiting lists for their own necessary treatments as doctors and nurses aren’t available to help them. Perhaps instead of shopping for patients, these hospitals could use their time and resources to, A) ensure hospitals are focused on meeting the care needs of Ontarians, B) find real solutions to improve and expand public health care, and, C) push the province to renegotiate the Health Accord with the federal government as one of their top priorities.
- It is important to note that while provinces across Canada face an ever increasing challenge to generate revenue for public health spending, due to the federal government's $36 billion strategic cuts to devastated public health care, robbing Peter to pay Paul isn’t the answer. With Ontario losing $14 billion in federal transfer payments for health care, there is no doubt a serious issue. But, it is deeply wrong to find money by making patients in Canada wait longer for access to needed care and hide this practice from the public’s view.
- Despite multiple requests, it is still unclear how much medical tourism is occurring in Ontario -- the Registered Nurses' Association of Ontario (RNAO) have had to file a Freedom of Information request to find out how much the Ontario government is behind this attack on our Medicare. In the afterglow of various scandals in Ontario and elections pledges having been made about transparency, it is foreboding that the Wynne government has decided to keep this ill-conceived scheme out of the public with no debate. It is also telling that before becoming deputy health minister, Dr. Robert Bell was president of the University Health Network (UHN is one the main hospital proponents for medical tourism). Prior to his appointment, in one interview he unashamedly boasted that he “made no apologies for the fact that the hospital was treating international patients” and said "plans were being made to do more of it." He also made the cavalier statement after the UHN secured malpractice insurance to cover Americans that, "We would estimate that including Americans in UHN’s International Patient Program would double Program revenues within two years." Curiously, after his appointment he changed his tone somewhat, proclaiming that "It has been something that has been one of the areas of strategic focus at UHN, but it is not something I will anticipate will be a focus at the ministry," and that the hospital was "not trying to drum up business among Americans or other patients from overseas." It is clear the fox was invited into the henhouse and we (yet again) need some real transparency from the provincial government.
- Medical tourism is part of a dangerous shift to develop for-profit, two-tier health care. If we allow our hospitals to treat international patients for money while not allowing the people in Ontario to take part in this unethical system, we are inviting a serious legal challenge to our public health care and expensive lawsuits in the near future. This isn’t hyperbole -- as we speak there are already other legal cases before the courts which seek to destroy our Medicare because provincial governments allowed for-profit, two-tiered, paralleled health care in through the back door. What we actually need now -- more than ever -- is a reinvestment in the ideals and principles of the Canadian Health Act and where universality and accessibility are paramount. Medical tourism and a two-tiered, for profit hospital system will inherently compromise the comprehensive and universal need based health care all Canadians deeply value. Make no mistake.
- There is a prevalent and logic-defying enthusiasm from both our provincial and federal government that money-making schemes are the miracle cures for our public health care system. This incorrectly presupposes that our system is broken, has poorer health outcomes or that it is more expensive than private ones (but that discussion is for another time). While there are strategically engineered funding shortfalls from the federal government, the rhetoric that our system is unsustainable unless we sell off services is a well documented false narrative. If we have learned anything in Ontario from the ORNGE or Ehealth scandals it is that when governments seek cure-all talismans and magic bean schemes, the result is the public health care system ends up paying the price for these ideological "innovations." Health care is a public good. Our attention should be on providing service and programs which strengthen health care as a public good instead of turning it into a fetishized commodity. Looking to the south we know all too well that when health care becomes a market commodity it serves to reinforce a privileged few at the expense of the rest of us.
- So who are hospitals for? This is a essential question and, as Dorris Grinspun outlines, "These type of sharp policy deviations from what the public believes is the deal they have with government as taxpayers is an aberration... The hospitals do not belong to CEOs; the hospitals in fact do not belong to boards of hospitals, they belong to the people that fund the system and that’s the patients that use the system and those that may need the system tomorrow." Hospitals are not a commodity to generate revenue -- they are public institutions to deliver important care when we need it most. They are about need, not greed.
Premier Kathleen Wynne and Health Minister Eric Hoskins need to immediately ban medical tourism to protect our public health care and its vital principles.
Learn more about medical tourism and sign a petition to the Premier and Health Minister here.
Join the conversation at #banmedicaltourism
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