Creating a Cross Border Solution

Cowichan News Leader

Published: March 04, 2010 6:00 AM

Dr. T. Rand Collins says he’s on a mission to help those stuck in long wait lines for MRI scans and other medical procedures.

It’ll cost for travel to the U.S. and for any procedures, but the work will be done and done quickly, promised the senior vice-president of the new western operations branch of International Health Care Providers Inc.

“Patients are willing to go someplace to get care or evaluations, but don’t know how to do it,” said Collins

“If you’re somebody with a back condition and are having trouble getting into the lineup here in B.C. and think about going to the United States, well you don’t know where to go, who the doctors are, you don’t know how to evaluate the system, how to pay for treatment, all of this kind of stuff.”

Collins, a retired U.S. pathologist, said IHP basically provides a road map for patients looking to get health care in the U.S.

“We will get your medical records and will also call one of the hospitals we deal with in the States to set up an appointment,” he said.

“You simply go to (an American city) with a prescription from your doctor in hand and you will get your scan there.”

The scan results will then be sent to the patient’s Canadian doctor, Collins said.

Initially and for good reason, it seems the new business will likely focus on MRI scans.

Shannon Marshall, a Vancouver Island Health Authority spokeswoman, said there are no delays for CT scans or emergency MRIs, but patients could wait up to 15 months from the date of the booking for non-emergency testing.

“Anyone who needs an emergency MRI does not have to wait for their test and there are no wait times for CT scans,” she stressed.

However, wait times for non-emergency MRIs are approximately 11 months in Victoria and approximately 14 months if people want it done in Nanaimo.

One of the challenges experienced by VIHA is the MRI is preferred over CT scans because MRIs give more detailed test results and do not use radiation.

VIHA currently has four MRI machines: three in Victoria — one at Royal Jubilee Hospital and two at Victoria General Hospital — and one in Nanaimo Regional General Hospital.

The machines operate seven days per week, at an average of 10 hours per day.

“Since 2003/2004 we’ve actually increased the number of MRI scans by about 30 per cent across the health authority,” said Marshall.

“Last year we did 22,500, but we had some one-time funding from the government to provide a lift.”

But this year is a different story, with the number of budgeted MRIs set at about 19,000.

That’s where Collins and his company come in. There’s no big secret why the Cowichan Valley was the first choice for the business.

“It’s actually a good place because we have lots of retirees on the island,” he said.

Carol Hunt, of Cowichan Seniors Community Foundation, said she welcomes the new business.

“There’s no shock and amazement that this sort of thing is happening, but more, ‘Hey, they’ve chosen the Cowichan Valley and isn’t that interesting?’” she said.

“I don’t know anything about the company … but it certainly reinforces what our seniors foundation has been preparing the valley for and that’s how we have to really pay attention to our growing, aging population and how our community is transitioning into a place where not only seniors are choosing to retire.”

“Obviously the company has done its due diligence in doing a market analysis and is of the opinion coming to set up shop here will be a viable business.”

Indeed, said Collins, but his company is not without its detractors.

“Some feel we’re deserting the (Canadian) medical system and in some ways could damage it,” he said.

“To me it’s akin to the American argument that legalizing gay marriage will damage the institution of heterosexual marriage.”

Collins hasn’t been hired by any local patients yet, but said he knows they’ll come.

“The idea of shopping for care is not really in the Canadian psyche, but the pros of using IHP include quick care, which is important when you’re hurting and on a waiting list,” he said.

“Also, in my opinion, the top end of technology in the States is higher than that in Canada.”

And, added IHP founder Kelly Meloche, it’s not as expensive as one might think.

“With regards to price, IHP clients benefit from a 55 per cent discount for MRIs and 45 per cent for CT scans,” she said from her Ontario headquarters.

“This means a person can wait in Canada for several months waiting for an MRI or they can pay $600, have an MRI the same or next day, leave with the (image) disk and have the interpretations within 24 hours as well,” she said.

Collins said instead of being in competition with the Canadian medical system, his company actually enhances it.

“What we may be able to do is take some stress off the system by taking away those people who can afford this option,” he said.

“The last thing we want to do is be seen as threatening or adversarial to the doctors here — we really want to be a service for the doctors who are trying to get care for their patients.”

For more information about the company, log onto www.ihcproviders.com.

An informed opinion of the Canadian vs US Healthcare model debate.

Dr. T. Rand Collins PhD, MD, LLC

The most unfortunate aspect of the health care debate in both countries is that the real issues, and the real strengths and weaknesses of each philosophy, get lost in the flag-waving.

There is a great deal of sniping back and forth across the border from those who would use both systems’ problems for their own political ends. Sadly, both systems are broken, but in different ways. The United States has excellent health care and world-class technology that is available quickly, but a significant part of the population cannot afford it. And another large segment of the population can just barely afford it, surrendering the equivalent of their mortgage each month just to be protected against a medical catastrophe. Canadians are privileged to receive complete care for a nominal cost – but to the patient who waits months with a painful and debilitating condition, this can be cold comfort.

In many cases involving cancer patients or acutely ill patients needing emergent care, the Canadian system performs well. My father had bypass surgery, and though there were no bedside phones and the surgery ward had last been repainted about ten years ago, he received excellent care, with home care provided for a nominal fee. That is the beauty, equality, and power of the Canadian system. However, for an extremely large number of patients with “non-emergent” conditions, wait times are long, services are limited, and patients experience significant pain and disability while they wait for treatment. “Non-emergent” does not mean that the condition can safely wait months for resolution.

The problem with the Canadian system is that it is totally government run, with no alternative available, and no competition to goad officialdom to improve services. Consequently, Canadians are stuck with what government provides – sometimes very good, and sometimes deadly slow.

The problem with the American system (and here I beat a personal drum) is that it depends entirely on the free market, and provision of good health care, I believe, does not fare well in an atmosphere oriented to profit. Sick people are not profitable, and in the end, they get the short end of the stick from an insurance industry that basically wants them to disappear. One of the elements of my belief system that I absorbed with my (Canadian) mother’s milk is that health care, like the ability to vote and express myself freely, is a right, not a privilege. Having lived for a quarter century in the U.S., I am still not convinced that many Americans have grasped this concept. I’m not sure that those who campaign fervently for the right to carry a Smith and Wesson really believe that their fellow citizens should be able to take their children to the emergency room without worrying about whether they can pay for it. Personally, I think that it is my responsibility to fork over a bit more in taxes to make sure that the immigrant kids down the road can get their eyes examined. i find it interesting that the health care systems in the U.S. that really provide equitable care (Medicare and the Veterans’ Administration) are both government run.

What is the answer? It’s complicated. Canadians need more flexibility and the ability to step out of the queue and buy care if they want to. Americans need to be freed from the crushing burden of paying for care that only the rich or the employed can afford.

Medical Travel is for ‘everyday folks’

For many years, Canadians maintained the notion that travelling for medical needs was a perk reserved for the affluent.  And, for many years, that paradigm was basically true.  Canadians were not waiting for health care and we had extraordinary physicians.  We still have extraordinary physicians but the waiting to see them ranges from serious frustration to sometimes death.

The press recently has brought to light the tragic stories of those that have suffered greatly in the absence of accessible health care.   It’s time to step aside from the sensationalism and get real.  Medical travel is now an opportunity for all.  Canadians are delicate when it comes to leaving their Universal system but that doesn’t mean they won’t take action.  It means they have to be guided and educated in a way specialized to their needs.

Our phone does not ring constantly with people clinging to their life.  It is the people like you and I…those of us raising a family, working to pay our bills and save for retirement  that are in need of health care sooner than later.  Whether it be an unexplained rash, a painless lump, or an ongoing dull pain, people now power through because they are dismissed at their doctors (if they have one) or are tired of being bounced around between tests where the left never seems what the right is doing.  It is people like ‘us’ that have no time for these  time consuming games thus choose to  incur the expense rather than endure the frustation.

US and overseas hospitals can often appear as predatory when it comes to their desire to attract Canadian patients.  Some of them are.  More importantly though, many of them are truly opening their arms and resources to serve as a helpful resource for those Canadians that choose to take charge of their own health care choices.  

Medical travel is here to stay and IHP will continue to lead the way.

Ethics, Integrity and Responsibility of a Medical Travel Facilitator

Kelly Meloche, President, International Health Care Providers Inc.

Having just returned from being the guest speaker representing Canadian patients at the Health Care Globalization Summit in Miami, Florida, I find myself , incredibly inspired and enriched.  This was an invitation only leadership conference where those of us interested in raising the bar of medical travel convened to share ideas, create opportunities and formulate standards.

As the regarded expert in medical travel for Canadians, I have spoken as the industry expert on both sides of the border, helped developed strategies for successful implementation of Internationl Patient Programs as well as created a business model that caters to the Canadian health care consumer, who despite somethimes having their lives in jeopardy, sometimes are more comfortable at working towards becoming “patient patients” rather than manufacturers of their own health care fate.

In 2003, when Canada was in full swing of the Universal Health Care rationale and struggling with wait time challenges, I was operating a wellness centre specializing in sports performance and chronic pain.  My clientele ranged from competitive athletes to grandmothers, all coping with severe pain.  It was here that I first experienced patients’ struggles with present day waiting lists within the Canadian system.   Witnessing patients forced to wait in pain and suffering while seeing this torment ripple through their families, was a tragedy from which I could not turn.

Along with this wonderful opportunity that medical travel offers Canadians, I also deeply caution potential medical travellers to be aware that this is currently an unregulated industry  This means that anyone can designate themselves as a medical travel facilitator and hide behind the smoke and mirrors of fictitious statistics and partnerships.  You need to arm yourself with questions and expectations.  Here  are some suggest questions to ask of your medical traveler facilitator:

• Who are your provider partners and why have you partnered with them?  What is your process for approving a hospital into your network?
• How do you get paid?
• Can I speak to former clients of yours before I make a choice?
• What is your background prior to entering into the Medical Travel Industry?
• How many clients have you facilitated in the past?
•  Can I speak to a representative of one or more of  the hospitals within your network to establish their satisfaction in working with you?

Working with a medical travel facilitator can relieve you of a tremendous amount of stress while expediting your care options at discounted rates.  Trust your instincts when deciding on what agency to work with and by all means, do not compromise quality for cost.  There are very few high quality, reputable agencies out there right now.  If it sounds too good to be true…then it probably is.

Taking your health care into your own hands is a liberating decision.  Yet delicate emotionally.  We are here to help you along the way.

The Value of PET/CT In The Treatment of Breast Cancer

With October being Breast Care Awareness month in the United States, I thought it was an appropriate time to discuss how PET/CT may make a difference with improving the clinical treatment of breast cancer.
While the use of PET/CT is not currently indicated for diagnosing breast cancer, it can make a difference in the following areas:
• PET/CT accurately stages axillary and mammary lymph node involvement. Axillary lymph node dissection is currently a routine part of breast surgery, since it is the only way doctors who don’t know about PET have of staging breast cancer.
• PET/CT may detect distant metastasis resulting in more accurate treatment.
• PET/CT is also used to evaluate the response to therapy. Treatment can be altered, if necessary, for better results.

• PET/CT is also used when there is suspicion of recurrent disease. Finding recurrent cancer early prolongs lives and increases the chance of beating the disease.
(1) Source: Clinical Positron Imaging Journal, the official Journal of the Academy of Molecular Imaging, Vol 3, Number 5, Sept-Oct 2000.
How does PET work?
PET (Positron Emission Tomography) is a non-invasive diagnostic imaging procedure that identifies abnormal glucose (sugar) metabolism. Since certain cancer cells metabolize glucose more than normal cells, which often occurs before changes in anatomy, PET may identify the presence of disease earlier than other anatomic imaging techniques. As a result, PET may offer important information to aid in more effective treatment.
Along with Breast Cancer, PET/CT is considered particularly effective include lung, head and neck, colorectal, esophageal, lymphoma, melanoma, cervical, brain as well as other less-frequently occurring cancers.

Brian Madison
President, The HCS Group

Dr. Brian Kleinberg educates patients to seek care sooner..not later.

Dr.  Brian Kleinberg, Chiropractor & Personal Life Coach.

Take a number. That is what the Ontario (and essentially Canadian) health care system has come to. We wait.  We wait hours. We wait days and weeks to get diagnostic test results.  We wait months to get an MRI. We wait months, and even years in some cases, to see a specialist. Many of us may compound these wait times as we have no family MD to direct our care. As a chiropractor I see patients who have waited way too long to get test results and see specialists before they are referred to me. In my chiropractic practice I educate my patients to seek care for their complaints sooner, not later. Yet, people have gotten used to the idea of waiting for health care. This is unacceptable. Seeking health care is not like buying meat in the butcher shop. We take a number to wait our turn to be served for meat. But we can wait – it’s not affecting our well being. Our health is our most prized commodity. We have relegated its importance to that of everyday household foods and products we purchase. But there are serious consequences for waiting for our health care. We suffer needlessly in pain. We may acquire new problems as our body compensates for the area of disease or injury. We defer critical decisions such as rehab or surgery which can lead to disability and in some cases, tragically death. The immediate availability of health care services should be a priority issue for all politicians and stakeholders. For that we shouldn’t wait.

Medical Isotope Shortage to Continue: Harper

Adel Boulazreg
September 2, 2009

The “National Post” reported that Atomic Energy of Canada Ltd. is going to be shut down its Chalk River nuclear reactors until 2010. This is going to cause many problems for Canadian patients. AECL’s reactors produce isotopes (such as molybdenum-99 & technetium-99) and a shortage of such means fewer diagnostics used to detect and manage cancer and other conditions, will be performed. Many people will go long periods of time without even knowing that they have a problem because these medical isotopes will not be available. The Quebec government is already reporting that it is seeking compensation and it expects the federal government to be supportive of the needs of the provinces.

Elsewhere in Canada, McMaster University is urging Ottawa to back its plan to produce the medical isotope which is currently in shortage. The university’s nuclear reactor needs about $30 million to cover costs for the next five years to meet the demand for the isotope shortage of molybdenum-99. Ottawa’s MDS Nordion also has a plan. It is proposing to the Canadian government that it commits to opening Canada’s only generator for manufacturing and generating devices that dispense technetium-99.

This medical isotope shortage is causing many problems, especially in Quebec where 27 000 have had their heart and cancer tests postponed: that is nearly 40% of isotope exams! Until this whole problem can be resolved, all Canadians needing such isotopes will have to go to International HealthCare Provider to be provided with the necessary care. What would Canadians do without the IHCP?

Taking Your Health Into Your Own Hands

On August, 21, 2009 a story was published in the Windsor Star entitled “When something’s growing in your head.”  It is a sobering tale of one womans deterioration that sadly mirrors the deterioration of timely access to health care in Canada.  It is a black & white reminder that you are never too sick to wait.

What would you do?  Take the next few minutes to imagine that you are acutely aware that your health is failing.  Each symptom, each pain and each intuitive urging continues to remind you that time is not on your side.  And yet, ridiculous as it seems, all you seem to have is time.  You spend agonzing hours waiting for tests and access to care during the day while the nights seem endless while you lay awake while gruelling ‘what-if’ thoughts continue to etch away at your psyche.

Shona Holmes waited 5 weeks for the MRI that would tell her she had a lesion on her pituitary gland just below her brain.  The doctors weren’t sure what to call it.  Shona was told that is could be a meningioma, a pituitary adenoma, a craniopharyngioma or a Rathke’s cleft cyst.  They know that several of these diagnosis point to a brain tumour, one even suggests a malignancy.  Swift action at this point is a no-brainer ~ but sadly ~ also not possible.  Shona was referred to two specialists.   A neurologist would be available to her after seven weeks and the endocrinologist would see her in 16 weeks.

Shona packed her bags and travelled to the Mayo Clinic where she received prompt, dedicated and specialized care.  Within seven days she had a diagnosis and a game plan.  Armed with this information and treatment plan, she returned to Canada firmly believing that her surgery, her urgently needed surgery, would be conducted immediately.  Wrong again.  She was to get in line again.  But she didn’t.  Good for her!  Shona returned to the US to have the surgery that ultimately restored her vision completely within ten days.

As Chief Justice Beverley McLachlin so brilliantly put it, “access to a waiting list is not access to health care.”  This article is posted in its entirety on my website www.ihcproviders.com.  I encourage you to read it and feel it.  You, your child, your best friend, your parent..anyone….anyone could be, or maybe is, a “Shona”.  And this must stop.

My philosphy is that you can either take action or stay silent.  Ongoing complaining does not solve problems, or in this case, save lives.  Everday I take action.  It is my greatest pleasure to connect Canadians to international health care Centers of Excellence that are not only leaders in health care but also true heroes of caring.  It works.  Medical travel is no longer for the affluent.  Paradigms have shifted and we now live in a world where health care excellence is sometimes down the street, other times a drive away and perhaps even at the other end of a plane ticket.   There are choices, there are answers but most of all, there is care.

The saying is so true.  If you don’t have your health ~ you don’t have anything.

CANADA IS AN IMPORTANT MARKET FOR MEDICAL TRAVEL

Canada is an important and growing market for medical travel.  Current estimates for Canadians finding private care for medically necessary procedures are approaching 100,000 annually.  Statistics indicate that this trend is growing steadily.  The backdrop for this trend is to be found in understanding the Canadian healthcare system and the unique culture of health that exists in this country.  As a Canadian and a medical facilitator in Canada, I am pleased to share my knowledge and experience.

The debate on public versus private health care in Canada is not new but it has never been so important.  And while many think they understand our dilemma many have been misinformed.  All you have to do is watch the documentary film, Sicko by Michael Moore to realize that the Canadian health care system is terribly misunderstood and sensationalized to adapt to political needs opposed to humanitarian ones.

Privately delivered health care is already part of healthcare in Canada.  Surprised?  When a Canadian patient walks into their family practitioners office, the clinic in itself is privately owned and operates on a for-profit basis and thus, the services rendered are privately delivered.  The same holds true for a local non-hospital lab or radiology centre.  Most of the services delivered however are publically funded i.e. covered by Medicare but additional ‘non-essential’ services are not.

In contrast, hospitals are government run entities and their services are publically delivered on a not-for-profit basis.  Currently, Canadians have the option to buy supplementary insurance to cover these non essential services which includes ambulance services, private beds and numerous other services such as cosmetic surgery and massage therapy that are not considered essential.

To further clarify, if a patient walks into their family practitioners office a physical exam will be covered but if they wish to further their care with a vasectomy, they will be billed for the procedure because it is not a covered procedure.  Fee schedules for each procedure are set by the government not the hospital or clinic. Each hospital has their own board and those boards are held accountable to the Regional Health Boards which are part of the government.   The Hospital Boards and Regional Health Boards spend considerable time pleading with the government for more money to provide the care that is needed.  An example of the cost versus care imbalance is that the charge for an amniocentesis (invasive test of a pregnant woman) is typically less than what many women pay to get their hair cut. 

Within the publically funded Canadian system, patients often experience long waiting times even for essential services such as emergency room visits, hip & knee replacements and even cancer treatment.  In the spring of 2009 the Canadian Press reported that Ontario cancer patients are still waiting twice as long as recommended for urgent and potentially life-saving surgery. This is especially alarming considering the combination of aging baby boomers and the fact that people are living longer with cancer.  It is anticipated that the number of Ontarians with cancer will jump from 275,000 to more than 400,000 by 2017 (Windsor Star, May 2008).  This has been referred to as a crisis on the horizon.

 In 2008 the Fraser Institute reported an estimated 750,794 Canadians were waiting for care after an appointment with a specialist.  Orthopedic surgery yields an especially long waiting list.  There were 92,626 procedures for which Canadians were waiting for after an appointment with a specialist in 2008.  The large majority of these patients are our baby boomers.  And for the boomers that are in their 40’s and 50’s it is not uncommon for them to find themselves as the care manager for their aging parent who is also in need of a similar surgery.  It is this waiting time, which can extend to years, yes years, which proves to be the detriment to sustainability of the patients quality of life.  Unfortunately, when referring to excessive wait times, most often excessive, is used to describe economic suffering.  The focus needs to shift to the significant costs reflecting the exhausting physical and emotional toll that waiting for treatment takes on the patients and their loved ones.

The Canadian Medical Association estimates that between four and five million Canadians are without a family practitioner.  In most provinces no more than 15% of doctors are taking new patients.  The Ontario Health Quality Council indicates that Ontario is producing more doctors than ever before, but access to family doctors has not improved since 2006.  About 7.4 percent of adults don’t have a family doctor, and half of that group, about 400,000, are actively looking for a doctor but can’t find one.

With respect to physicians in Canada, they are self-employed yet only paid by the government.  They negotiate their compensation much like a union dues, thus their earnings have a ceiling.  Many of the waiting list woes have been created by physicians refusing to work beyond what their salary allows.  To avoid working for free, they simply manage their billable hours to accurately reflect their negotiated earnings.  This, obviously, has added to Canada’s waiting list problems yet the population of patients, on a whole, has a sense of understanding and compassion for the doctors despite the suffering that it may cause personally.

Canada has just two thirds as many doctors per 1,000 population as the OECD average. Canada’s current population stands at just over 33 million.  We would need 26,000 additional doctors just to bring ourselves up to the norm for industrialized countries.  And the situation is likely to get worse before it gets better.  The average Canadian physician is 50 years old.  Due to retirement and population growth, an additional four or five million Canadians will be without a regular doctor by 2018, the CMA estimates.  At any given social gathering, it is now common place to discover that at least one person in the room is suffering from the emotional and physical distress that inaccessibility to health care provokes.

Canadians have been socialized to be all accepting and never questioning of our health care system.  Paying for health care procedures can immediately manifest feelings of betrayal or disbelief just as placing trust in a ‘foreign’ doctor can feel treasonous.  This is the emotional junction that either becomes the prison or the catalyst when it comes to care.  To understand the opportunity one must also understand the culture, the history and the system.  Our baby boomers have been raised to have the solitary experience of submitting their health care card in exchange for all of their medical services.  Words related to cost were never spoken.  “Choice” was also omitted from our health care vocabulary. My intimate knowledge of the Canadian culture and the ability to respond to the unique needs that each Canadian patient represents has proven invaluable.  Extensive research and hands-on experiences continues to illustrate that Canadians are timid and generally acultured to taking very little responsibility for their health care…even when their lives are at stake.  We do what the doctor says, or in this era, we wait to see what the doctor will say and pray time doesn’t prove deadly.

Obtaining health care outside of Canada is a choice.  For some it is a blessing.  For everyone it is an education.  Trust is the most critical component in such an undertaking.  Quickly we are learning that heading south for care isn’t just for the affluent.  It is for anyone willing and capable of shifting from the wait list to the VIP (very important patient) list. We also understand that state-of-the-art medical facilities do exist without out-of-this-world price tags for procedures.  The number of Canadian medical travelers is growing.  With positive experiences to share with friends and family, we can expect this trend to continue.

Kelly Meloche brings her years of experience as a Tactical Communications Instructor for the Province of Ontario as well as her credentials as a Sports Performance & Chronic Pain Specialist forward to help Canadians find the solutions to their health care needs.

As President of International Health Care Providers Inc, Kelly provides seamless facilitation of Canadian patients to her network of superior international health care partners.