Bureaucracy over healthcare?

CARP takes up the case of an Ontario woman who won’t be reimbursed for life-saving cancer surgery because of red tape.

Is our healthcare system delivering what’s needed or does bureaucracy rule the day?

Consider the case of Sylvia de Vries from Windsor, Ontario. In October, 2006, she paid $60,000 in the U.S. for life-saving ovarian cancer surgery. If she had waited only two weeks, her doctor said she would have suffered multi-system failure that would have rendered her unstable for surgery.

When she later filed her application for compensation, it was denied by OHIP – not because the surgery was deemed unnecessary, but because the bureaucratic processes were not followed in order. Ms. de Vries’ application for out-of-country coverage was made after she started the treatment, which is in violation of a provincial requirement.

It is a decision that has many crying foul, including CARP.

“There are enough problems in the health care system without having to fear not being reimbursed for out-of-country coverage just because of red tape,” says Susan Eng, vice-president of advocacy for CARP.

Seniors who depend on the public health care system need to get the care that they need when they need it, and that is the general promise of our public health care system, she says, adding, “The mere fact that some bureaucratic processes were not followed in order should not block the reimbursement.”

To pay for the operation, de Vries and her husband drained their savings, maxed out their credit cards and opened a line of credit, the Windsor Star reported. Friends rallied to the cause by raising $11,125 in a spaghetti dinner fundraiser.

In Windsor, thousands have joined in signing a petition that will be presented to the Ontario legislature, calling for a full reimbursement by the minister of health.

CARP urges action

CARP called upon Health Minister George Smitherman to authorize reimbursement after his office announced that he would not intervene in the OHIP decision. In a letter dated, March 14, 2008, CARP wrote in part:

“As you know, CARP has advocated for better and more timely health care, especially critical care, and where it is not available in Ontario, that it be paid for by the Ontario government. We accept that there must be proper review processes but to deny reimbursement in this case because she failed to get prior approval is simply unacceptable.

The bureaucratic and unsympathetic answers given on your behalf by Ministry spokespeople are a great disservice both to Ontarians who rely on the health system when they are most in need and to your own reputation for compassion and common sense.”

To read the letter in full, click here.

More bureaucratic barriers

This is certainly not the only case where patients find themselves paying for urgent medical procedures out of pocket because of bureaucratic barriers. In recent news, yet another Ontario woman, Ida Moretto, received only partial reimbursement for cancer treatment in Detroit, more than a year after she died from effects of the disease, according to media reports. Ms. Moretto had received treatments out of country in 2005.