Regional News
November 26, 2009 09:39 AM
A Metroland Special Report
Melinda Dalton, Joe Fantauzzi and Matthew Strader
Diane Ingersoll admits she felt a little guilty when she crossed the border.
In pain for weeks, the 64-year-old Georgina resident said she awoke one morning this month in agony.
The pain in her right shoulder had begun about six months earlier, she said.
“I was doing three, four hours of sleep a night,” she said.
It had been five weeks since Mrs. Ingersoll had been referred to get an MRI, she said. After hearing nothing about when the scan would be available, she and her husband, Tom, took the matter into their own hands, crossing the United States border and paying $875 US for two MRIs in Amherst, NY.
Mrs. Ingersoll is not alone.
More stories from across the province
Cross-border health care facts
Columnist Debora Kelly's take
Today, according to the province, 74,867 Ontarians are waiting for an MRI – almost as many as the number of people living in Newmarket.
Initially, Mrs. Ingersoll said she tried to tough it out. She got some acupuncture and took a holiday with her husband.
“You hate to run to a doctor for a pain in your shoulder,” she said from the couple’s Keswick home.
Almost immediately upon their return, Mrs. Ingersoll said she contacted her family doctor, who thought she might have a torn rotator cuff or bicep, and filled out MRI request forms.
Days later, after hearing nothing from the lab to which her MRI forms had been sent, Mrs. Ingersoll called and was told she was not in the lab’s system.
After what the couple characterized as a series of miscommunications and with no date set for her MRI, Mrs. Ingersoll woke up in pain Nov. 12.
Mr. Ingersoll said he called a hospital in Mississauga and a private MRI clinic in Quebec.
The hospital referred Mrs. Ingersoll to someone the couple referred to as a “middle man” in Mississauga.
The middle man had connections to a private MRI clinic in Amherst that had appointments available.
Within five hours, the couple was across the border and at the clinic.
She said she has since been diagnosed with a fractured vertebrae and shoulder impingement.
“I don’t want to bad-mouth our system, but until you’re in the midst of something like this, you don’t realize the limitations,” Ms Ingersoll said. “Funny enough, you feel kind of guilty.”
Long waits, unavailable procedures and poor physician access are driving record numbers of Ontarians to seek treatment south of the border and, sometimes, overseas.
Metroland’s special report, Cross-Border Care, shows:
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A 450-per-cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a period of explosive growth in new technologies and therapies not covered or available here.
The province agreed to fund 2,110 procedures or treatments in 2001 and 11,775 last year.
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Patient demand has created a new breed of health system navigators, known as medical brokers, who find U.S. options for the growing number of Ontario patients who elect to pay for medical services south of the border themselves.
Medical brokers negotiate discount rates with U.S. centres to get Ontarians faster diagnostics, second opinions and surgery.
Brokers say that for every patient sent south by the Ontario government, there may be up to 10 others who go — and pay — on their own.
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Ontario’s spending on out-of-Canada medical services has tripled in the past five years. Payments in 2010 will balloon to $164.3 million, from $56.3 million in 2005.
The province said in last month’s economic forecast it needs to increase health spending by $700 million to cover “higher than anticipated” OHIP costs, including services outside the province.
While out-of-country spending is a small part of the $11 billion OHIP pays for all patient services a year, the increase is significant, Ontario’s health minister says.
“Are we looking at ways to reduce out-of-country? Absolutely, yes,” said Deb Matthews, who became health minister last month.
Ms 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 of Health and Long-Term Care continues to negotiate preferred rates for Ontario patient visits to U.S. health centres, the Metroland investigation shows.
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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 “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.
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The province does not track the number of Ontarians crossing the border for care on their own, never seeking government pre-approval 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 and diagnostic evaluations “when they’ve exhausted options in Canada”, said 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.
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Ontario continues to struggle with wait times. This month, almost 140,000 people are on wait lists just for CT scans and MRIs.
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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.
The out-of-country care system last came to wide public attention when an investigation by the Ontario Ombudsman prompted the Health Ministry to order an independent review two years ago.
That three-month appraisal — led by Mary Catherine Lindberg, a former assistant deputy minister of health — identified some weaknesses that could undermine the ability of doctors and
patients to get needed out-of-country care.
Ms Lindberg’s 2007 review followed Ombudsman André Marin’s investigation into the case of Suzanne Aucoin of St. Catharines.
Ms Aucoin, who died in 2007, was denied funding for the chemotherapy drug Erbitux, but was later reimbursed more than $75,000 and given an apology by the province.
Mr. Marin said the out-of-country system is so confusing, “it’s as if they hand a dying cancer patient a Rubik’s cube and they’ve got to figure it out themselves. It’s a real cruel game.”
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The Metroland investigation has also found: The health services appeal and review board, the independent body set up to hear a wide range of health-related appeals, does not track or report
on how many of the cases it reviews involve OHIP refusals for out-of-country care.
It also has not made public an annual report in almost four years.
An official of the board said its only legal obligation is to file annually to the ministry and has done so.
There is no indication why the reports have not been issued publicly — as they were from 2001 to 2006.
Patients say they face long waits for appeal hearings before the board when OHIP refuses to pay. The board says the average wait for a hearing is about seven months, then three more months for a decision.