The average wait time in Canada
for orthopedic surgery is about 25 weeks. But for a
fee, Dr Jeffrey Brock can have your patients fixed up
in 10 days or less. His company, Montreal-based Med
Extra, will take care of everything for patients suffering
from anything from "hang nail to heart attack": diagnosis,
second opinion, MRIs, pre-op consultation, an operating
room and surgeon — located in a private clinic
in Canada or, more likely, in the US. Plus, patients
will pay a fraction of what the operation might cost
if they went at it alone. And business, Dr Brock says,
is booming."Very few people wake up and say they need
to go to the US for treatment," says Dr Brock. "It's
intimidating, time-consuming and it's expensive. A lot
of people, however, do wake up and say they need help
that they simply can't get right away in the public
health system."
People like Dr Brock have come
to be known as "care brokers." With the dire state of
wait times, his company is providing what is essentially
an escape mechanism for patients unable or unwilling
to wait for treatment in the public system. Some people
may worry these services represent yet more creeping
privatization of our healthcare system — especially
in our current volatile political atmosphere. Others
may be reminded of a socialist system gone wrong —
these brokers are similar to the blatnoi or fixers of
the old Soviet Union whom the well-connected called
in order to grease the wheels of government services
or jump the queue.
LEGAL
SPECIALISTS
But care brokers here operate within the law.
"We have hundreds of thousands"
of specialists in Canada, the US and even Israel to
which Med Extra regularly refers patients, says Dr Brock,
noting his company's services do not contravene the
Canada Health Act or use public medical facilities.
Med Extra makes money by charging
a percentage of the savings the customer gets by going
through the company. For example, if hip replacement
usually costs $25,000, but Med Extra can secure the
surgery for $12,000 the customer is charged a percentage
of the difference of $13,000.
TWO
TIER REALITY
Such facilities are popping up all over Canada, particularly
in BC and Quebec, where there are a number of private
surgery and MRI clinics. Given the Quebec government
has decided to comply with the Supre-me Court ruling
which struck down its law banning private health insurance,
noting there must be alternatives available for patients
if the public system fails to deliver timely service,
care brokers could be more in demand than ever.
"Timely Medical Alternatives [a
BC-based care brokerage] sends us an average of one
or two clients a day," says Dr Mark Godley, a surgeon
who founded the private False Creek Surgical Centre
in Vancouver in 1999. "They refer clients to us, and
because we can't do full hip or knee replacement surgeries,
we send people to them." A care broker would have to
send these referred patients across the border as the
BC Health Act explicitly bans private clinics like False
Creek from performing hip or knee replacements.
Dr Godley, who spent 15 years in
the public system, suggests care brokers will be around
for as long as the public system is broken. "In the
public system, the patient is an irritant, because it's
a system based on rationing. Our patients are customers,
so they are treated like gold."
Canadian Medical Association president
Dr Ruth Collins-Nakai says the concept of care brokering
has a long history in the country. The first time she
heard of it, she says, was in the early 80s, when many
elderly and terminal care patients were turning to these
brokers to manage their care. It's only recently that
care brokering has gone beyond this, into elective surgery,
she says. "I think that the rise of all these things
is an indication that the health system isn't working
well enough for the average person," she says.
Though going to private facilities
might seem anathema to most proponents of public healthcare,
care brokers themselves say what they do actually alleviates
pressure on the backlog of surgeries and procedures
in Canada. "We're a relief valve for the Canadian medical
system," says Rick Baker, president of Timely Medical
Alternatives (TMA), used by Dr Godley's clinic.
SPEEDY
SERVICE
Established in 2003, the company's website boasts they've
"helped our clients to regain their mobility, to get
relief from chronic pain, to get diagnosis of illnesses."
Mr Baker says TMA can get a host of services, including
diagnostic imaging, CT scans, ultrasound, bone and PET
scans "within 24 hours in a private clinic in Vancouver."
He also has several anecdotes about a variety of miseries
suffered by his patients as they wait for care.
"We had a lady fly all the way
from Winnipeg to Vancouver for an MRI, which is readily
available, but would have taken six weeks in Winnipeg,"
says Mr Baker. "She thought it was cancer so she spent
$2,000 for her and her husband to fly to Vancouver for
an MRI. Isn't that crazy?"
Even among those who think this
whole thing stinks of social injustice, many pin the
blame on government's failure to adequately invest rather
than the care brokers for profiting off gaps in coverage.
Even Jean Crowder, the Health Critic for the federal
New Democratic Party — well known for its opposition
to any sort of private medical service — doesn't
vilify the brokers. She sees them as a necessary evil
in a healthcare system as overwhelmed as Canada's. "What
it does point to is a need to take a look at what's
wrong with our public healthcare in this country," says
Ms Crowder. "The question is, why are we putting people
in the position that they have to use them?"
For his part, Mr Baker says he
provides an essential service — particularly to
the elderly, who make up the bulk of his clientele.
"We have clients who are in their third week of waiting,"
he says. "We had a 65-year-old lady who mortgaged her
house for a $50,000 operation. And why not? She was
lying in bed, and her life had basically stopped."
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