Medical tourism is bad business for Canadian hospitals

For the other side of this debate, see Marnie Escaff & Nizar Mahomed’s Caring for international patients improves care for Canadians

Sunnybrook Hospital in Toronto has recently been in the news for its new method of revenue generation: offering care to wealthy foreign patients – aka “medical tourists” – who are able to pay out-of-pocket for healthcare. This practice veers significantly away from the underlying premise of Medicare in Canada: patients should be seen based on need, not on ability to pay. It is my opinion that medical tourism should not occur in Canada.

The practice introduced by Sunnybrook isn’t new. Toronto’s University Health Network has raised millions of dollars by seeing international patients on a referral basis. However, unlike the UHN, Sunnybrook is actively marketing in other countries to create awareness that it is “open for business.” UHN claims that it does not market its services, however, UHN President and incoming Deputy Minister of Health Robert Bell, declined to say what patients are charged for services, citing the competitiveness of the marketplace.

There is no doubt that hospitals are struggling for funding, and that it is tempting to see medical tourism as a way to address financing issues. However, care needs to taken so that the cure isn’t worse than the disease.

Following significant media attention, including a letter to Ontario’s Premier Wynne from Canadian Doctors for Medicare and other partners, requesting a ban on two-tier healthcare, Health Minister Deb Mathews has announced an informal review of medical tourism. The areas to be looked at include whether public money is being used for medical tourists, whether Ontarians are waiting longer for care because of medical tourism, and whether revenue generated from fee-paying foreign patients is going back into the public healthcare system.

Medical tourism should not be confused with medical humanitariasm. The long-standing humanitarian programs that welcome patients from other countries or assist in sharing Canadian expertise with developing health systems are activities of which we are rightly proud. Advertising to attract wealthy patients as a means to fund Canadian hospitals is something quite different.

Attracting medical tourists — individuals with the financial means to choose to travel abroad for medical treatment — is a risky practice, both from the points of view of financial sustainability and the delivery of equitable care.

Here are my concerns:

Medical tourism represents a shift to for-profit, private healthcare. Healthcare in Canada is rooted in the notion of accessing services based on need, not ability to pay. Creating a second tier contravenes the principles of Medicare, and also establishes a precedent for the wealthy to access care ahead of others. It would be reasonable for a wealthy Canadian to ask why they aren’t able to pay for care in a Canadian hospital.

In a recent debate on CBC’s the Current, Dr Robert Ouellet, former Canadian Medical Association President and current Senior Fellow with the Fraser Institute, argued in favour of medical tourism. He then made the jump to needing to change the Canada Health Act to allow this type of for-profit activity, exemplifying the slippery slope medical tourism can lead to.

“Unused capacity” should be used to treat Canadians. Many Canadians are on waiting lists for procedures and services. If hospitals have empty facilities, and physicians, nurses and other staff needing work, the provincial and federal governments should be working together to better use those resources to reduce waiting times for Canadians. Is it fair to be marketing interventions to medical tourists if we can’t meet our own needs?

Resources may be lost from the public system. It takes many healthcare workers and support staff, from doctors and nurses, to administrators and cleaners, to keep a hospital functioning. If those workers are focused on medical tourists, they are not focusing on Canadians in the public system.

Lack of continuity of care and patient safety. If a Canadian pays for care in another country then returns to Canada for follow-up, healthcare providers may have difficulty coordinating proper care. By treating medical tourists in Canada then having them return to another country, Canadian hospitals may create the same challenges for international healthcare workers. There are also risks inherent to long-distance travel that may be increased by flying before/after a medical procedure.

In a Globe and Mail Op-Ed, Colleen Flood from the Evidence Network asks, “If medical tourism is the solution, we’d best ask first, what’s the problem?” If the issue is insufficient money for hospitals, then that should be addressed at the provincial and federal levels.

If hospitals are seeking ways to obtain stable, sustainable long-term funding, relying on the uncertainties of medical tourism, while undermining Medicare, does not seem to be a reasonable solution. It is telling that this controversy is arising just after the federal government decided to underfund Ontario through its new formula for allocating healthcare dollars.

This situation could also be an impetus for broader conversations around hospitals priorities. Money, although necessary for healthcare, is not always sufficient to address challenges. It is not clear whether there is a specific gap in service provision that UHN or Sunnybrook are seeking to supplement with money from medical tourists. There may be other innovative approaches that could be taken, in addition to seeking funding.

The core problem with medical tourism is that it gives preference to patients based on their ability to pay, rather than on need. If hospitals require additional funding to be able to conduct their business, we should seek ways of supporting healthcare locally, provincially and federally, in ways that do not create inequities in the Canadian healthcare system.

For the other side of this debate, see Marnie Escaff & Nizar Mahomed’s Caring for international patients improves care for Canadians