Your Health Update

Out of Country Medical Expenses

CARP is hearing more and more about the frustration and fears of people who have had to seek medical care outside of the country because the Canadian health system was unable to deal with their medical emergency. The latest case was reported in the Globe and Mail on August 9, 2008. (To read the article click here.) There is no question that successive governments have tried to deal with wait times and doctor shortages. However, the Canada Health Council recently reported that five years after the Canada Health Accord was signed with great fanfare, there has been only modest improvement.

Canadians are not overly demanding or unreasonable but they do expect that the health care system will be there for them when they really need it.

In fact, the policy makers know very well that the system cannot guarantee this and every province has a program to pay for out of country medical care, subject of course to conditions as to medical necessity and urgency. But they must get prior approval. The government agencies CARP contacted claimed that they have improved their approval processes.

However, when people cannot wait and pay for the cancer surgery, for example, themselves, they face an uphill battle to get reimbursement.

In an earlier newsletter, we profiled two people facing this dilemma in Ontario and their cases are held pending the outcome of an appeal to the divisional court scheduled for this October. Nearly 90 cases are in that queue at this time although some of them were also rejected on the substantive aspects.

Since then, we’ve heard from readers in Alberta and others in Ontario.

This cannot be allowed to go on. At the very least, the strict enforcement of the prior approval requirement should go. In British Columbia, there is a special procedure to provide retroactive approval.

CARP is monitoring the appeals and will be looking at ways to intervene as well as taking this position to the new Minister of Health in Ontario.

PET Scans

Lack of access to PET scans continues to be a concern for our members. Positron Emission Tomography (PET) scanning is a vital diagnostic tool that is publicly funded in most provinces in Canada. PET scans have been used clinically for over 20 years.

However, access to PET scans varies widely. At present, British Columbia funds 3,000 PET scans annually. Alberta will fund approximately 3,500 clinical PET scans in 2008. Manitoba is funding up to 1,000 PET scans annually. This will double to 2,000 scans annually with the new cyclotron in Winnipeg. Quebec has funding for 21,000 patients per year. Even the smaller provinces have respectable access: New Brunswick’s operational funding is set at $1.335 million to perform 600 PET scans annually with one PET/CT scanner in Saint John. This funding is expected to double when a second PET/CT scanner opens in Moncton in 2008 or 2009. Nova Scotia will fund 1,500 PET scans annually with its new PET/CT scanner.

Access to PET Scans in Ontario depends on eligibility for clinical trials, a registry program and a tribunal process. In the net result, less than 2,000 patients are being covered in Ontario per year compared with the actual capacity of the 6 centres which could help at least 6,000 people per year and the estimated 24,000 cancer patients who could benefit from a PET scan in diagnosing and managing the treatment of their disease.