Why Ontario keeps sending patients south to the USA

More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here. Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins. “They rushed me over to Detroit, did the whole closing of the tunnel,” said Eric Bialkowski, 47, of the heart attack he had on March 14, 2007, in Windsor, Ont. “It was like Disneyworld customer service.”

While other provinces have sent patients out of country – British Columbia has sent 75 pregnant women or their babies to Washington State since February, 2007 – nowhere is the problem as acute as in Ontario. At least 188 neurosurgery patients and 421 emergency cardiac patients have been sent to the United States from Ontario since the 2003-2004 fiscal year to Feb. 21 this year. Add to that 25 women with high-risk pregnancies sent south of the border in 2007.

Although Queen's Park says it is ensuring patients receive emergency care when they need it, Progressive Conservative health critic Elizabeth Witmer says it reflects poor planning. That is particularly the case with neurosurgery, she said, noting that four reports since 2003 have predicted a looming shortage. “This province and the number of people going outside for care – it's increasing in every area,” Ms. Witmer said. “I definitely believe that it is very bad planning. ...We're simply unable to meet the demand, but we don't even know what the demand is.”

Tom Closson, the Ontario Hospital Association's president and chief executive officer, said 30 per cent of Ontario's hospital medical beds are currently occupied by patients awaiting more appropriate placements, such as assisted living centres, a nursing home, a rehabilitation facility or even their own homes with proper home-care supports. That squeezes the system at both ends: Patients in intensive care units whose condition improves cannot get into step-down units, and some emergency patients can't get a bed at all, he said, adding that “everything is jam-packed at the moment.” A method for determining the right mix of beds and health services required in Ontario needs to be developed, he said, noting that that task has not been undertaken on a provincial basis for a decade.

Laurel Ostfield, press secretary to provincial Health Minister George Smitherman, said that in emergencies, where the patient goes becomes a clinical decision. It is preferable for someone with a heart attack in Windsor to be sent to Detroit, a few kilometres away, rather than on a long ride to London, Ont.

When demand has peaked, government has responded, she said. It struck a neurosurgery expert panel to study the problem and $4.1-million has been provided to stem the tide of U.S. neurosurgery patients. As well, stand-alone angioplasty services were created in Windsor in May.

Canadian Medical Association president Brian Day said he couldn't speak about the Ontario problem, but noted this country is the last in the Organization for Economic Co-operation and Development to finance hospitals with global budgets. Under that model, patients – and often doctors – are sometimes viewed as a financial drain. “We keep coming back to the same root cause,” Dr. Day said in a telephone interview from Ottawa. “The health system is not consumer-focused.”

Patients first learn of the problem when they are critically ill. Jennifer Walmsley went to Headwaters Health Care Centre in Orangeville in October and was diagnosed with a cerebral hemorrhage due to a ruptured aneurysm. That acute-care hospital does not have neurosurgery and no Ontario hospital that does could take her. She was then rushed to a Buffalo hospital. Headwater's chief of staff, Jeff McKinnon, said three neurosurgery patients have been sent to Buffalo in the past year. Others have gone to Toronto, Mississauga, Hamilton and London.

Radiologist Louise Keevil said Headwaters has an arrangement with neurosurgeons at other Ontario hospitals to send electronic images for their assessment, but “the limiting factor is availability of beds in their hospital. “The physicians are very accommodating but their hands are tied by availability of service.”

Kaukab Usman had a heart attack after a gym workout in Windsor on Dec. 9. She was rushed to hospital and given clot-bursting drugs. When they failed, she was sent to Henry Ford Hospital in Detroit, where she had angioplasty on one clogged artery and two stents inserted. “It was a miracle for me to be alive,” Ms. Usman said in a telephone interview from Somerset, New Jersey, where she is recuperating.

Aaron Kugelmass, director of the cardiac catheterization laboratory at Henry Ford Hospital, said a system is in place to get these patients the care they need expeditiously. “We try to make their length of stay in the U.S. as short as possible,” said Dr. Kugelmass, associate division chief of cardiology. “If they are stable for discharge, we discharge them to home in Windsor, with clear follow-up plans.”

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Health Insurance: Problem or Solution?

Is universal, mandatory health insurance what we want, or do we really want to provide health care to those that need it?

I am baffled that there are numerous grassroots efforts to provide health insurance for the uninsured, yet none to actually provide health care for those in need. According to recent reports from the Census Bureau, the number of uninsured increased 2.2 million in 2006 over 2005 to 47 million or 15.8% of the population. Part of this increase was due to a decline in insurance provided by employers. This decline in coverage might just be because the typical family plan offered by employers rose 7.7% to a staggering $11,480!

There has been great excitement that universal health insurance is at least part if not all of the answer to our health care woes. What is really discouraging is that even conservative, "market-based", "consumer-driven" and "individual accountability" proponents tout universal insurance coverage as the answer. I submit that "insurance" is a big part of the problem and no part of the solution. Here is why I reach that conclusion:

* "Insurance" can be defined as the equitable transfer of a (predictable) risk of a potential loss from one entity to another, in exchange for a premium and duty of care. The "potential loss" is usually of a nature that a person would not inflict it upon themselves, their property or others. I fail to see how this definition can be applied to health care any more than it can be applied to the upkeep and maintenance of a house or vehicle, (which, by the way, is why we don't have "health" insurance for cars and houses). Insurance providers are "risk-takers" not administrators.

* Somehow we managed to survive and thrive since the "beginning" without modern health care or health insurance. Why is now any different?

* Health care costs began to spiral upward at about the same time that "health insurance" was introduced during World War II as a way to sidestep wage controls. As insurance has become mandated and regulated, the spiral has accelerated. Hmm, I wonder why? There are still a few procedures and services that aren't covered by insurance AND most are still within financial reach of the average person.

* Each fix, mandate and regulation was supposed to reduce cost and/or improve quality. PPO's, HMO's, HSA'sthey were all supposed to be the great fix yet they each seem to have made the problem worse. Doesn't this tell us something? Like maybe more of the same just might possibly be counter-productive?

* There is no market for health insurance, if there were, the government would not have to force employers to provide it to their employees, rather, we'd be purchasing it of our own accord. I wonder what might happen to the employer that may choose to rid himself of the headache and give the $11,480 to the employee andheaven forbidlet the employee make his or her own decisions?

* Lack of insurance does not affect access to or quality of health care. The unimpeded access of millions of illegals to our health care services at little or no cost is proof enough.

* Just like taxes, most people have a "use it or lose it" attitude toward health insurance. There is no incentive to be prudent. Get your money's worth or more even if you don't need it. Better yet, "someone else" is paying for it, so who cares? Is "inflationary" the correct word?

* The June 2007 Reader's Digest had 220 numbered pages. Within those 220 pages were (by my count) 44 pages and inserts for 11 prescription drugs that most people would opt not to purchase (or would at least think about real hard) if "someone else" weren't paying for it.

* Why does a heart valve replacement in the US start at about $200,000, when you can go to India to an Indian doctor trained in America using American equipment and American parts and have it done for under $10,000? I argue that it boils down to insurance for 2 reasons: 1) insurance provides no incentive for "frugality" and 2) lawyers don't sue doctors, they sue insurance companies.

* And finally, the corker. San Francisco and others require that health insurance cover sex change procedures! WOW! Talk about a moving target! So what IS health care? Who decides? Who should pay for it? Why?

There is no place for health insurance in consumer driven health care, unless, of course, you want "someone else" to foot your bill. Furthermore, it is downright laughable to even consider health insurance as a part of socialized health care. The only way to socialize health care is to Federalize the health care industry and tell the insurance companies to get lost, right? I mean, aren't they supposed to make a profit? That's not supposed to happen in a socialized system, right?

The only real solution is a consumer-driven health care system where the consumer makes the decisions and pays the bills. There are many that do just that. I am a member of a group of 12,000 other families that believe it is OUR health and OUR money therefore we are, must be, and have a right to be good stewards of both. We make our own health care choices, are responsible for payment, and our needs are shared among our group.

Here's an idea. What would happen if the employee were to choose between 1) insurance coverage paid for by the employer or 2) cash payment of the $11,480 that is spent on the typical employee health insurance premium? I think we know the answer, which is why it will never happen.

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