Caring for international patients improves care for Canadians

For the other side of the debate, read Monika Dutt’s Medical tourism is bad business for Canadian hospitals

In recent weeks a few people have written about international patients in Canadian hospitals, “medical tourism” and the “slippery slope” that the writers all seem to believe will inevitably lead to two-tiered medicine.  We are responsible for the international programs at University Health Network and have read what has been written with surprise and disappointment at the lack of information about what is happening within hospitals with regard to international patients and international work – and what has happened for many, many years.

One of our first international patients was Elizabeth Hughes, daughter of the Governor of New York, who came to the Toronto General in August 1922 to receive the new miracle drug insulin in treatment of her diabetes.  Thirty years ago Dr. Joel Cooper performed the world’s first successful lung transplant at Toronto General and a number of the first lung transplants were performed for American patients since Canadian doctors were unwilling to refer patients because transplant was considered too risky. Recently UHN celebrated the 50th anniversary of the discovery of blood forming stem cells at Princess Margaret Cancer Centre which meant that we were one of the early international providers of life saving bone marrow transplant, a procedure which was not available in many countries and still not available in some countries.

Today, University Health Network has an active international program which benefits our own patients, the individuals who work here and the small number of international patients who receive care within our organization.  Last year 86 patients came from a number of countries – while we saw over a million visits from our own citizens.

The use of the terms ‘medical tourism’ or ‘medical tourist’ makes for a sensational headline, but in no way describes the people who came to us last year or any other year.  The patients we see are receiving care that is not available in their home country.  In the majority of cases, their government pays for the care they receive here or their insurance covers their care.  To call them “medical tourists” diminishes their need for expert care and suggests a frivolous use of resources.  Nothing could be further from the truth.

The largest number of people who came to UHN last year were from Libya and they had been wounded in that country’s civil war.  Given the state of Libya’s health care system at this time, the Libyan government has looked for care for their citizens in many countries including Canada.  This work is largely done on an outpatient basis and involved the fitting of prosthetics, some surgical revisions to enable the use of prosthetics and the rehabilitation necessary to help people adjust to the loss of an arm or a leg. Our brave armed forces helped to liberate Libyans from an oppressive regime. We were asked to help repair the damage to civilians caused by the civil war and were happy to help.

The Libyan government pays for this care and with the revenues generated by this arrangement, UHN opened two additional inpatient hospital rooms and one additional operating room (OR) for the year.  These beds and the OR were also available to Ontario patients and helped us reduce the waiting list for hips and knees and for fractured bones. Many Ontario’s hospitals – including UHN —  have unused OR’s and patient rooms so the funding received from the Libyan government allowed to us to hire staff to open two previously unused beds and an OR. When not used by Libyans these extra resources were used by Ontarians- and Ontarians were able to use these facilities about 85% of the time.  Contrary to much of what has been written about the subject, this work allowed us to shorten the waiting list for Ontario patients, not lengthen the list.

Canada is blessed with some of the finest health care professionals anywhere in the world.  Our health care system has contributed much to global health and the fact that people want to come to Canada to access some of the leading edge procedures should be a source of pride.  In addition, treating patients from other countries is a very, very small part of our international activities.  Of greater impact is the work we are doing internationally in a consulting capacity and we are very proud of the fact that UHN and Canadian healthcare in general is held in high regard internationally.

Our work with Kuwait, which is a consulting role, is the best example of an international program which benefits UHN and Canadians by supporting needs within our own system while broadening our experience internationally.  Our health care professionals learn much from our Kuwaiti partners – learnings which are brought back to Canada and available to our own culturally diverse population.  Kuwait is interested in learning from us because they want to develop and build the capacity to treat all of their own citizens who have cancer and we applaud that ambition and are delighted to be invited to work with them on that goal.

The revenues from this work have funded improvements to the facilities at Princess Margaret Cancer Centre and will also allow us to invest in a new electronic patient record.  These funds are critical to our ability to continue as Canada’s leading research hospital – something that is of great benefit to the citizens of this province and Canada as a whole.

We engage in international work because we want to treat more patients from our province with better resources.  We want to invest in cutting edge technology and we want our health care professionals to have the opportunity to work internationally if they have the interest.  Investing in new technologies requires more funding than is available at this time from the Ministry of Health and Long Term Care and international work provides us with revenues to invest in these advances for Ontarians.


For the other side of the debate, read Monika Dutt’s Medical tourism is bad business for Canadian hospitals

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  • Tom Closson says:

    This is well said.

    Canadians should be proud of the skills their doctors, nurses and other staff have to offer the world in high quality, leading edge healthcare. And Canadians should be open to having their healthcare staff learn from the experience of providing services to people from other countries. We should not be myopic.

    • Abhi Mukherjee says:

      Thank you Marnie Escaf and Nizar Mahomed for your perspective. I agree with Tom Closson that we should not be myopic. Newspapers find readership through sensational headlines – but the reality is that to lessen the burden on Ontario taxpayers, we need to be creative and find alternate revenue sources. Spreading paranoia about out-of-province or international patients is detrimental to our own interests. If we want cutting-edge technology, we should be open to capitalizing on our expertise to generate revenues that will fund innovation. That is the smart thing to do.


Marnie Escaf


Marnie Escaf is is Senior Vice President of University Health Network and Executive Lead of Princess Margaret Cancer Centre.

Nizar Mahomed


Nizar Mahomed is Medical Director of UHN’s Arthritis Program and Managing Director of UHN International.

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