Angela Bugera, the owner of an art gallery in Edmonton, Alberta, was experiencing hip deterioration that was interfering with her daily tasks and forcing her to walk with a cane.

She was put on a waiting list for a hip replacement at the Hip and Knee Clinic, which manages a centralized surgery triage process for Alberta. But her doctor advised her to explore private treatment options she might be able to access more quickly, because her pain was so severe and her mobility was becoming impeded.

After a worldwide search for a suitable clinic, taking into account the additional costs of flights and weighing up a range of options, she decided to seek treatment at Health City Cayman Islands in 2015.

Angela paid approximately $18,000 Canadian dollars ($14,100) for the cost of the surgery and hospital stay. She feels the overall investment, including additional travel and lodging costs, was worth it. 

“We went off-season and stayed for a glorious three weeks,” she said. “The total cost was $25,000 Canadian to regain at least one year of my life. I would have been waiting at least one more year in our system.”

Bugera is far from alone. While Americans have been crossing the border for years in search of cheaper medications, it turns out there are a growing number of Canadians seeking medical treatment south of their border, raiding their bank accounts and choosing to pay for treatment instead of being treated through their nationalized health care system. In 2014, more than 50,000 Canadians left the country for medical treatment, a 25 percent increase from the previous year. A similar number left the country for treatment in 2015. 

Why would someone pay for something they are entitled to receive for free?

According to The National Post, the answer comes down to a choice between time and money ― a choice that’s only available to those privileged enough to be able to finance expensive out-of-pocket medical expenses up front.

The Fraser Institute released a study last year showing that wait times in Canada were on the increase and had hit an all-time high in more than two decades of the think tank conducting the survey. Patients reported waiting up to 20 weeks for “medically necessary” procedures such as organ transplants and heart surgery. Experts have blamed this increase in wait times on a number of factors, including different branches and departments of provincial government not communicating effectively, a lack of doctors in some areas, and people living longer and therefore requiring more care.

Free health care isn’t always comprehensive enough to cover all patient needs, explained Dr. Bernard M. Dickens, professor emeritus of health law and policy at the University of Toronto.

“Canadian ‘universal’ health care is not fully universal. It covers ‘medically necessary’ treatments, particularly in hospitals, but does not cover cosmetic and many dental treatments,” he said. “Canadians may pay for services out of the country that are considered not ‘necessary’ or that are still experimental or ‘unproven.’”

Dr. Mathew A. Plant, a plastic, reconstructive and aesthetic surgeon based in Toronto, has seen the dark side of medical tourism. He warns patients to very carefully research their chosen medical facility and insist on seeing current licenses and qualifications. He finds these patients typically fall into two groups: those traveling for cheaper cosmetic procedures, which often carry risks of inferior care and complications, and those seeking medical treatment outside their home country to circumnavigate long wait lines and leapfrog the system. 

Universal health care ensures that nobody ever goes bankrupt to pay for their medical needs, but there are holes in the system.

“Everyone has access to free medical care that is ‘good enough.’ If you want to pay for better health care, you can’t,” he said. “That’s why those who can afford to, tend to go down to the U.S. for care if they have anything serious happen to them. You can have the greatest doctors in the world, but if the bureaucrats that run the system are making them treat patients with one hand tied behind their back, are they going to be delivering the best possible care?”

Whatever the underlying causes of these excessively long wait times or the motivation of patients to seek quicker medical treatment, they are leading some to worry that medical tourism is creating a two-tier system: one in which the wealthy can afford to get quicker treatment and the poor have to wait or go without.

It’s not just long wait times that have some Canadians shopping for medical care out of the country. Canada is home to just over 35 million people, and with a population that small, there aren’t always enough specialists to cope with demand. This leads some patients to seek consultations and advice outside of Canada to access a greater range of facilities and specialists, and to tap into a greater pool of expertise.

Sue Morin, 40, a remote administrative assistant from Ottawa, began experiencing unexplained pain in 2002. She became frustrated by Canadian doctors’ lack of answers and over-reliance on prescribing pain medications, and decided to seek a second opinion overseas after finding they weren’t taking her symptoms seriously enough.

For about $10,000 Canadian dollars, she was able to travel to the Mayo Clinic in Rochester, Minnesota, stay in a hotel for two weeks, pay for meals, undergo medical tests and have consultations and interviews with doctors and staff. She returned to Canada with a written report of their findings, a diagnosis of fibromyalgia and a recommended treatment plan. The treatment plan was then followed in Canada under her prepaid provincial health care coverage. For Sue, having answers and a clear plan moving forward was worth the cost.

Many doctors working in Canada, like Plant, believe in the ideal of free health care. However, they recognize the system is not perfect, and sometimes money can buy superior medical care or at least quicker access.

Plant says that when patients travel out of the country to beat the long wait times and not for financial savings, they often wonder why they didn’t do it sooner.

For these Canadian patients, when it came to the decision between cost and time, the choice was easy. Their quality of life trumped any doubts about having to pay for treatments. Angela Bugera still exalts the benefits of a free health care system but knows that changes are needed.

“Universal health care is very important, but our system is overwhelmed and we should be looking at options to supplement it until it can support us all again,” she says.

Rachel, 51, an elementary school teacher in Ontario who asked that her name be changed in order to discuss personal health matters, found herself traveling to the U.S. in 2001 to seek treatment for an undiagnosed gynecological condition that had already eaten up almost two years of her life in consultations, misdiagnoses and referrals. She decided to take the matter into her own hands and research alternatives. Once she found a doctor willing to treat her, she finally had an answer to her chronic pain. An American surgeon who treated her in California found endometriosis, appendicitis, bowel adhesions, a hernia and uterine fibroids. The surgery, hospital stay and hotel costs added up to more than $30,000 Canadian dollars out of pocket.

“I got a breakdown of all expenses, down to $18 for three cotton balls,” she said.

Although the cost was significant and required her to dip into her savings, Rachel believes it represented value for money compared to the alternative.

“The system in Canada is a little broken at the moment and there need to be processing strategies in place for patients,” she said.

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