Passport to Health

The Canadian Way
In Canada, the experience is a little different due to our public healthcare system. “There’s still some expectation that the public system in Canada is going to give [people] what they need,” says Marilee Mark, vice-president, marketing, with Manulife Financial. In the 2008 sanofi-aventis Healthcare Survey, more than half of respondents said the quality of the Canadian healthcare system and the medical services it provides are good; 35% said the quality is very good or excellent. Only 13% said it is poor or very poor.

It’s unlikely that employers would consider offering medical tourism as a benefit—even a voluntary one. According to Mark, Manulife is not receiving any such requests from employers. “They’re interested in offering more voluntary benefits,” she says, “[but] this one isn’t coming to the top of the list.” And, she adds, people are only truly interested in the benefit at the time of need. “In other words, buy it when you need it, as opposed to buying an insurance product to cover you in case you need it.”

Although Canada ranks ahead of the U.S. in the World Health Organization’s health systems ranking (No. 17 versus No. 30), wait times are still a concern for Canadians. According to a 2008 survey by the Fraser Institute, wait times for surgical and other therapeutic treatments averaged 17.3 weeks, and Canadians waited for more than 700,000 procedures. The percentage of Canadians waiting varied by province, from 1.6% in Ontario to 4.7% in Nova Scotia.

The real motivation for medical tourism by Canadians, says Yasmeen Sayeed, president and chief executive officer of Surgical Tourism Canada, is desperation. “It’s people who are on wait lists, have waited long enough, are fed up and want to get [the procedure] done quickly with their own money.”

Sayeed adds that certain procedures are not offered in Canada because the technology is not available. For example, she says, the Birmingham hip resurfacing procedure is non-invasive, provides better quality of life and lasts longer than the traditional hip replacement. “In a publicly funded system, there’s only so much technology you can keep up with. There are only about four or five surgeons throughout Canada who are trained in this procedure.”

Yet, Canada values its healthcare system, despite its limitations. “When we talk about our values in Canada, it speaks to the fact that we have to deliver the best healthcare system to Canadians,” says Joseph Ricciuti, client solutions leader, Canada group and healthcare, with Watson Wyatt Worldwide. “Canadians should not have to leave the country for services to find the cheapest deal. [But] they may have to go province to province for access.”

Travel Expenses
While the chances of Canadians seeing medical tourism on the benefits roster any time soon are slim, there are other options. Karen Millard, a consultant with Towers Perrin, says employees could use a healthcare spending account (HCSA) for eligible out-of-country expenses. LIMRA’s 2008 Employee Benefits in Canada survey found that 20% of benefits plans now offer an HCSA, and nearly 40% of plan members rate their HCSAs as important.

“It would have to be an eligible expense,” says Millard. “For example, the [Canada Revenue Agency] has generally said that as long as the services are provided by a licensed and regulated physician in the jurisdiction, it’s okay.” However, most HCSAs aren’t well funded, which limits employees’ options. “The average HCSA is probably not large enough to pay for something out of country,” says Mark. “If you’ve got any [funds], you’ll use them toward [the procedure], but they are not going to pay for the bulk of it.”

There are certain circumstances, such as facilitating a faster return to work, in which a person can get reimbursed for out-of-country procedures. “If you’re a Workplace Safety & Insurance Board case, it’s in the interest of the WSIB to have you treated and back in the workforce as quickly as possible,” says Sayeed.

And while the majority of Sayeed’s 120 clients have been paying out of pocket for their surgical procedures, there are a few exceptions. “We’re seeing some success in Ontario,” she says. “OHIP has, after certain appeals and requests, reimbursed some [people] for their expenses.” (Case in point: a few years ago, the Globe and Mail reported that Ontario schoolteacher Bob McDonnell, who opted for a hip replacement in India, was reimbursed for his medical costs.)

Since it may be awhile until employers offer medical tourism as a benefit—on both sides of the border—Americans will have to keep digging deeper into their pockets. And Canadians will just have to do what we do best: hurry up and wait.

Brooke Smith is associate editor of Benefits Canada.
brooke.smith@rci.rogers.com