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7 www.oakvillebeaver.com · OAKVILLE BEAVER Thursday, November 26, 2009 · 12 Ontario is bulk buyer of American health services Wednesday, November 18, 2009 OAKVILLE BEAVER Continued from page 1 "Are we looking at ways to reduce out-of-country? Absolutely yes," said Deb Matthews, who became health minister last month. Matthews says her ministry is taking steps to improve services and access across Ontario so fewer patients will need to go to the U.S. At the same time, though, the ministry continues to negotiate preferred rates for Ontario patient visits to U.S. health centres, the Metroland investigation shows. · Ontario has become a major contractor -- a bulk buyer -- of American health services this year. Since spring, the ministry has entered into funding contracts with U.S. hospitals, imaging clinics and residential treatment centres. It has these "preferred provider" contracts in place with about 40 American medical providers now -- and is accepting solicitations from others. Contracts cover diagnostics, cancer care, bariatrics and adolescent behavioural disorders. The ministry says the agreements ensure "more immediate services for patients whose health is at risk." It has declined to release details of any of the agreements. · The province does not track the number of Ontarians who cross the border for care on their own, never seeking government preapproval or reimbursement. But major U.S. medical centres contacted by Metroland -- including Detroit's Henry Ford Health System and the Mayo Clinic -- say both government-funded and private-pay patient lists are growing. The Mayo Clinic, which sees about 600 Ontario patients a year, says top reasons include wait times Wait Time Insurance What it is: A privately obtained insurance that allows Canadians who have excessively long waits for procedures to obtain services at private U.S. clinics. What it costs: Monthly premiums for wait-time insurance range from $100 to $200 a month. How it works: Typically, benefits kick in when a covered person is on a wait list for more than 45 days. Coverage includes costs for diagnostic tests and treatment for hundreds of medical conditions. Coverage is subject to terms and conditions of the particular policy. PHOTO ILLUSTRATION BY SCOTT GARDNER, THE HAMILTON SPECTATOR www.oakvillebeaver.com and diagnostic evaluations "when they've exhausted options in Canada," says Mariana Iglesias of the Minnesota-based clinic. OHIP's pre-approved funding program for out-of-country care is supposed to fill gaps in health care for high-risk Ontarians. But patients who use the system express repeated concerns -- about the time it takes to get OHIP approval and to appeal, if refused. "I really believe they make it as difficult as possible," says Janet Nancarrow of Ottawa who is preparing for an OHIP appeal hearing for her 34-year-old daughter, Lisa, who is taking part in a clinical drug trial at the Mayo Clinic. Lisa has "Are we looking at ways to reduce out-of-country? Absolutely yes." Deb Matthews, Minister of Health tumours that are encasing her vital organs and invading her system. Her doctors and family say the trial is her only option short of endof-life palliative care. With no outside help, Nancarrow said, she had to research precedent cases, find expert witnesses and keep up with enormous paperwork -- all while accompanying her daughter back and forth to Minnesota for treat- ments. "They shouldn't put families through this," she said. · Ontario continues to struggle with wait times. This month, almost 140,000 people are on wait lists just for CT scans and MRIs. · Wait-time insurance policies have emerged as the industry caught on to public angst. While no industry figures exist to indicate the level of consumer take-up of the coverage, plans are available to reimburse costs of private treatment when policyholders are forced to wait more than 45 days. Ontario says it has made strides to reduce waits for the priority procedures it monitors. But the Ontario Health Quality Council -- which the ministry set up to review provincial progress -- says more needs to be done. "Many Ontarians still wait too long for urgent cancer surgery, MRI scans ... and specialists," the council says in its 2009 report. Ontario NDP Leader Andrea Horwath says the OHIP out-ofcountry surge has taken on momentum and that government must stop the southbound flow. "The government needs to reinvest the dollars that they're shoving out the door to private providers of health care in the States, and invest that in providing services here at home," she said. Go to the end of the line Ministry of health figures show the number of people on official wait lists, as of Nov. 1: · MRI scans: 74,867 · CT scans: 61,506 · Cancer surgery: 5,086 · Hip replacement: 3,890 · Knee replacement: 8,684 MRIs and CT scans have been among the most-requested U.S. procedures for years -- due to long Ontario wait times and proximity to U.S. border-city clinics. The province reported that the wait for an MRI was 109 days at the end of September. The province's target wait time is 28 days. More patients going south for treatment By Melinda Dalton, Joe Fantauzzi and Matthew Strader METROLAND MEDIA GROUP Christine Elliott, Ontario Progressive Conservative Health Critic, says she wants to know what's being funded "to know if there are specific trends ... to look at the system of delivery of care and where changes need to be made." Sheila Acker of the Henry Ford Health System says the Detroit area medical centre has seen its Ontario patient population grow. Many come for bariatric services (weightloss surgeries for the dangerously obese, through gastric bypass or banding) provided through one of the preferred-provider contracts the ministry has arranged. But Acker says not having OHIP funding has not preclud- ed people from coming. "If they are concerned about a health issue and know it will be a long wait, we're 10 minutes from the Windsor border. If they don't want to wait for their procedure, that's who we're seeing." · New technology that's unavailable in Ontario is also an issue, especially in genetics. Genetic tests -- in which a person's chromosomes are examined -- are widely used now to predict disease and help diagnose illness. Out-of-country requests to OHIP for such testing have increased 200 per cent in five years. That's because Ontario has not kept up, said Dr. Suzanne Kamel-Reid, head of laboratory genetics and director of molecular diagnostics at Toronto-based University Health Network. "The number of tests available in the U.S.have increased, and we in Ontario haven't kept up with having the same amount of tests available," said Kamel-Reid. Matthews, the health minister, says this is a high-priority issue the government is trying to remedy. She said the ministry has identified the five highest-volume genetic tests, and is trying to improve access to them here. When a person has metastatic colon cancer, for example, a test can be done for the presence of a mutation in a specific area of a specific gene. That helps doctors know whether the patient will respond to certain therapies. But out-of-country care focuses most heavily on patients, not tests. · Requests by Ontario patients for funding of care across the border have more than dou See Confused page 13