How are things going in Canada for patients ? Not too badly, except for long waiting periods
In 2016, an estimated 63,459 Canadians
received non-emergency medical treatment
outside Canada.
Physicians in British Columbia reported the
highest proportion of patients (in a province)
receiving treatment abroad (2.4%). The largest number of patients estimated to have left
the country for treatment was from Ontario
(26,513).
Across Canada, otolaryngologists reported
the highest proportion of patients (in a specialty) travelling abroad for treatment (2.1%). The
largest number of patients (in a specialty) travelled abroad for general surgeries (9,454).
One explanation for patients travelling
abroad to receive medical treatment may relate
to the long waiting times they are forced endure in Canada’s health care system. In 2016,
patients could expect to wait 10.6 weeks for
medically necessary treatment after seeing a
specialist—almost 4 weeks longer than the time
physicians consider to be clinically “reasonable”
(7.0 weeks)
Introduction
By estimating how many Canadians receive
health care outside the country each year, and
the type of care they receive, we gain some
insights into the state of health care and medical tourism.
Canadians who choose to seek treatment
abroad do so for several reasons, many of which
may relate to their inability to access quality
health care in a timely fashion within Canada’s borders. Some patients may be sent out of
country by the public health care system due
to a lack of available resources or because some
procedures or equipment are not provided in
their home jurisdiction. Others may choose
to leave Canada because they are concerned
about quality (Walker et al., 2009) and are seeking more advanced health care facilities, stateof-the-art medical technologies, or better outcomes. Others may leave in order to avoid some
of the adverse medical consequences of waiting
for care, such as worsening of their condition,
poorer outcomes following treatment, disability,
or death (Esmail, 2009; Barua et al., 2013; Day,
2013). Some may leave simply to avoid delay and
to make a quicker return to normal life.
While there is no readily available data on the
number of Canadians travelling abroad for
health care, it is possible to produce an estimate of these numbers from data gathered
through the Fraser Institute’s Waiting Your
Turn survey and from the Canadian Institute
for Health Information (CIHI), which tallies the
numbers of procedures performed in Canada.
Across Canada, otolaryngologists reported the
highest proportion of patients (in a specialty)
travelling abroad for treatment (2.1%), while the
lowest proportion of patients (in a specialty) travelled abroad for ophthalmology (0.8%) (see table 1).
Combining these percentages2
(table 1) with
the number of procedures3
performed in each
province and in each medical specialty gives an
estimate of the number of Canadians who likely
received treatment outside the country.
Results
Table 2 indicates that a significant number of
Canadians—an estimated 63,459 people—may
have received treatment outside of the country in 2016. This is a significant increase from
the 45,619 who were estimated to have travelled abroad in 2015 (Barua et al., 2016) and also
higher than the 52,513 who were estimated to
have travelled abroad in 2014 (Barua and Ren,
2015).
Increases between 2015 and 2016 in the estimated number of patients going outside Canada
for treatment were seen in seven provinces: British Columbia (10,315 to 15,372), Alberta (4,616 to
9,067), Ontario (22,352 to 26,513), Manitoba (702
to 2,052), Quebec (3,360 to 4,603), Saskatchewan
(from 712 to 1,888), and Nova Scotia (1,466 to
2,438). Conversely, in that period there was a
2 Readers should note that this calculation uses the
exact values, not the rounded values that appear in
table 11 in Barua and Ren (2016).
3 Data are for 2014/15 from the Discharge Abstract
Database (CIHI, 2016a) and the National Ambulatory
Care Reporting System (CIHI, 2016b), and the Hospital Morbidity Database (HMDB) (CIHI, 2016c). For
further details see Barua and Ren (2016).
decrease in the estimated number of patients
who received treatment outside Canada in
Newfoundland & Labrador (from 1,151 to 669),
Prince Edward Island (52 to 7), and New Brunswick (894 to 851).
Table 2 also shows the estimated number of
patients receiving treatment outside of Canada by specialty. For example, we estimate that
approximately 9,454 Canadians travelled abroad
in 2016 to receive general surgery. On the other
hand, we estimate that only about 210 Canadians went abroad to receive radiation oncology
treatment in 2016.
Limitations
There is a temporal mismatch between the timing of the Fraser Institute’s Waiting Your Turn
survey and the CIHI’s annual data release. Specifically, procedure counts data used for Waiting Your Turn are typically one year behind
(e.g., the 2016 edition of Waiting Your Turn
used procedure counts from 2014/2015). While
the calculations above use the temporally mismatched procedure counts to provide up-todate information, previous calculations adjusting for the temporal mismatch show that it
does not appear to materially affect the trend
witnessed in the overall count of Canadians.
However, it does, as expected, affect the actual
counts of Canadians (Esmail, 2007).4
The number of patients receiving treatment
outside Canada each year produced by this
methodology is likely to be an underestimate.
This is the result of a few factors. Most impor4 Specifically, the Canadian counts with the temporal mismatch for 2004, 2005, and 2006 were 49,392,
44,022, and 39,282, respectively. Accounting for the
mismatch, the counts for 2004 and 2005 were
Discussion
These numbers are not insubstantial. They
point to a sizeable number of Canadians whose
needs and health care demands could not be
satisfied within Canada’s borders.
There are a number of possible reasons why
this may have been the case. Some patients
may have been sent out of country by the public health care system due to a lack of available
resources or the fact that some procedures
or equipment are not provided in their home
jurisdiction. Others may have chosen to leave
Canada in response to concerns about quality (Walker et al., 2009), seeking more advanced
health care facilities, more state-of-the-art
medical technologies, or better outcomes.
Another explanation may relate to the long waiting times that patients are forced endure in
Canada’s health care system. For example, in
2016, patients could expect to wait 10.6 weeks
for medically necessary treatment after seeing a specialist.6 This wait time (which does not
include the 9.4 week wait to see a specialist)
is almost 4 weeks longer than what physicians
consider to be clinically “reasonable” (7.0 weeks).
Thus, it is possible that some patients may
have left the country to avoid some of the
adverse medical consequences of waiting for
care, such as worsening of their condition,
poorer outcomes following treatment, disability, or death (Esmail, 2009; Barua et al., 2013;
Day, 2013). At the same time, others may have
left simply to avoid delay and to make a quicker
return to normal life.
Conclusion
In 2016, an estimated 63,459 Canadians
received non-emergency medical treatment
outside Canada. In some cases, these patients
may have needed to leave Canada due to a lack
of available resources or a lack of appropriate procedures or technologies. In others, their
departure may have been driven by a desire to
return more quickly to their lives, to seek out
superior quality care, or perhaps to save their
own lives or avoid the risk of disability.
Clearly, the number of Canadians who ultimately receive their medical care in other
countries is not insignificant. That a considerable number of Canadians travelled abroad and
paid to escape the well-known failings of the
Canadian health care system speaks volumes
about how well the system is working for them
Leaving Canada for Medical Care 2017
