New York medical brokerage gains ground in Canada
Post Media News (February 12, 2011)
By Tobi Cohen
This article appeared in the Victoria Times-Colonist, Ottawa Citizen and Vancouver Province
A Buffalo-based company is the latest to get in on the medical brokering scheme that’s gaining ground in Canada as lengthy wait times force more and more people south of the border for treatment.
Cross Border Access has been helping Canadians book appointments and negotiate fees for a variety of procedures in upstate New York since May, putting a new twist on an industry that’s raising ethical questions and helping fuel the private-public health-care debate.
Unlike Canadian companies that have popped up offering similar services, this American operation charges a $200-a-year membership fee and connects patients directly with service providers.
Company founder Ed Meyer added his work in the American health insurance business gives him an advantage over his Canadian competitors.
“Because of our experience in the American health-care delivery system, we can do a better job of getting good prices and screening the provider to make sure they are qualified,” he said.
Noting U.S. health care is a free-market system, the same diagnostic imaging scan can cost anywhere from $900 to $2,000. He said most Canadians probably wouldn’t realize that when they look to the U.S. after learning it could take months for their CT scan, cancer treatment or knee replacement in Canada.
He’s built relationships with diagnostic facilities, hospitals and physicians in Buffalo and Niagara Falls, N.Y., and is intent on hooking up Canadians from southwestern Ontario through the Toronto area with quality affordable care.
“We don’t take any money from health-care providers in the U.S. and we don’t give any money to Canadian health care providers who refer patients to us,” he added.
“Our only source of revenue is the membership fees from patients so we don’t get into any ethical grey areas about sending people to specific providers or facilities because that’s the best financial arrangement for us.”
Among his competitors is B.C.-based Timely Medical Alternatives - one of the first and most successful brokers - which makes its money by charging a mark-up and has recently waded into the controversial area of paying physicians for referring patients.Founder Richard Baker recognizes it’s a “contentious subject, ” but noted it’s done in the best interest of patients and doctors who don’t want the marketing fee - about $1,000 for a hip replacement patient, for example - can opt to have it donated to a medical charity of their choice.
“A lot of our business comes from doctors who refer their patients to us because their hands are tied as far as being able to get them surgery,” he said. “It’s in the patient’s best interest that they get speedy surgery almost always and … we’re happy to pay for that.”
Baker said he’s helped thousands of people secure treatment since opening for business in 2003, most of them from Alberta, B.C., Ontario and Saskatchewan.
Noting business last year has more than doubled over 2009, he’s not surprised to learn another company has emerged with a new twist on the medical brokerage model, but insists his service is tough to beat.
He’s secured partnerships with 22 facilities in 10 states - the cheapest of them being those in the Midwest - and because he pays them directly for medical services up front, they avoid having to fill out a lot of paperwork, are happy to get business they would not otherwise receive and therefore give him the best rates.
In turn, he adds a “little bit more” to the patient’s final bill, though he won’t divulge the exact mark-up nor does it typically appear on a patient’s invoice.
“They don’t care that we’re paying a little bit less,” he said. “They understand that we have to make a profit.”
Over the years he’s seen a number of similar ventures pop up, and for the most part, fail. Citing the case of Windsor-based EcuMedical Resources International, whose founders are now facing fraud charges for allegedly taking money from patients seeking medical procedures in the U.S. and failing to pay the facilities, he also cautions consumers to be vigilant.
While few up-to-date studies examining the prevalence of medical tourism among Canadians exists, an Angus Reid poll earlier this year found 40 per cent of Canadians said they would pay out of pocket to jump the queue and 42 per cent would leave the country to seek treatment.
A 2008 analysis in the McKinsey Quarterly business journal pegged the global medical tourism market at between 60,000-85,000 people and noted 40 per cent were seeking out advanced technologies. Among them, seven per cent were Canadian.
The emergence of a groundbreaking new treatment for multiple sclerosis that few Canadian provinces have agreed to examine has certainly spawned a number of stories over the last year about Canadians engaging in medical tourism and highlighted some of the safety concerns given the death of a Canadian man in October from complications at a Costa Rican clinic.
But support for medical tourism itself and the business of cross-border brokerage appears split among those in the medical community.
Canadian Medical Association president Jeffrey Turnbull describes it as a byproduct of the Canadian system failing to meet the needs of its citizens.
“As long as wait times remain as long as they are or even worsen, Canadians who have resources will do what’s best for their own particular health,” he said. “If that means going south of the border or another jurisdiction outside of North America, they will.”
While the CMA believes no Canadian should be denied health care because they can’t pay for it and ultimately supports the principles in the Canada Health Act, Turnbull said it also supports improving competition and involving the private sector in health care delivery.
Fort Erie, Ont. family physician Maynard Luterman doesn’t mince words when he says he’s a “two-tier type of guy.” Wait times for things like chronic pain, child psychology and back surgery, he said, are unacceptable and he believes those who have the means to pay should be able to do so and that medical brokers offer a valuable service.
Meanwhile, Michael McBane of the Canadian Health Coalition believes medical brokers are “shysters” who are “exploiting vulnerable people” and who “waive” all responsibility and liability should something go wrong.
He argues wait times are often exaggerated and that medical tourism raises concerns about continuity of care and the appropriateness of treatments that may not be approved in Canada.
“What we’re working hard to do is make sure Canadians have access closer to home,” he said. “We want doctors and other people in the health system to be part of the solution and not find ways to game the system through kickbacks and bribery and queue-jumping.”
Dr. Philip Berger, a physician and University of Toronto professor, said Canadians have a right to purchase medical services wherever they want but argues Canadian taxpayers shouldn’t have to foot the bill.
Those who use the Canadian system for initial consultations and diagnostic testing before ultimately deciding to seek surgery in the U.S., for example, ought to reimburse their provincial plan, he said.
The same goes for follow up care in Canada, he argued, adding medical tourists shouldn’t be allowed to “piggy-back” on the Canadian health care system.
He also argues finders fees are “highly improper” as patients will never truly know whether the advice given was in their best interest.
