Knee-deep in pain, frustration Canada Health Act won't allow Winnipegger to pay for joint replacement at private facility in home province
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Hey there, time traveller!
This article was published 26/11/2021 (255 days ago), so information in it may no longer be current.
A Winnipeg woman doesn’t understand why she could pay out of pocket for a new knee in Calgary, but she can’t pull out her wallet to get the procedure here.
The woman, who didn’t want her name used, said she would prefer to get her knee replaced here in the public health-care system, but as the wait for surgery lengthens she would be willing to pay for it at home.
But she can’t, and it’s because of the Canada Health Act.
The same federal law that provides universal health care to residents at home allows Canadians to pay for a procedure as long as they travel to another province to have it done.
“It’s very wrong,” the woman said. “If I can go to Calgary to pay for knee surgery, why can’t I pay here? I’ve been on the waiting list for two years already and I was supposed to get surgery before the end of this year. Now they are saying it will be in April to June, but that was before they had more cancellations lately.
“Who knows when this will be done?”
Pandemic-related adjustments in the health system have worsened an already-long wait; an estimated 136,000 surgeries and other procedures are backed up, including more than 8,000 patients waiting for hip and knee replacements.
Former Winnipeg travel agency owner Max Johnson, who recently spent about two weeks in Lithuania getting a knee replacement, has submitted a $14,000 bill to the provincial government, which he said is thousands of dollars less than what it costs here. He argues Manitoba Health could quickly shrink the waiting list for hip and knee replacements ― and save money ― if it paid to have people flown to the same Lithuanian clinic.
The Free Press has reported on two Manitobans who were able to get new hips or knees months earlier than they could have got them here because they paid for the procedure at Clearpoint Surgery Centre in Calgary.
Clearpoint Health Network is one of the leaders in private surgeries in Canada, with locations in Calgary, Toronto, Mississauga, Vancouver.
Dr. Chris Cobourn, Clearpoint’s chief medical officer, said the Winnipeg facility in the Maples is only allowed to do insured services on Manitoba residents.
“We have long-standing contracts with Shared Health and the Winnipeg Regional Health Authority,” said Cobourn. “Over 95 per cent of the procedures done at Maples are publicly funded (by either) government or WCB (Workers Compensation Board).”
Clearpoint is fully supportive and compliant with all aspects of the Canada Health Act, he said.
“If staying within their home province for care, the CHA stipulates that medically necessary elective surgical procedures be provided and covered by the provincial government. These medical services cannot be billed to the individual directly.”
A provincial spokesperson confirmed that’s the case for Manitobans.
“Provincial legislation (The Health Services Insurance Act) includes provisions to ensure that the requirements in The Canada Health Act are met in Manitoba,” she said.
“I can confirm The Health Services Insurance Act prohibits charges to patients for insured services.”
No private surgeries should be allowed in Canada that are paid for in the public system, said Arthur Schafer, the founding director of the University of Manitoba’s Centre for Professional and Applied Ethics.
“The government should not allow health-care resources to be siphoned off,” said Schafer. “In general, the government has turned a blind eye.
“But the underlying ethos is supposed to be health care is a necessity of life available to everybody based on need, rather than based on how wealthy you are.”
Doctors can be paid directly by patients by agreeing not to receive payment from government for any procedures, a spokeswoman for Health Canada said.
“Should a physician choose to become ‘unenrolled’ from the public plan, they may not bill the public plan for services they provide and they can charge patients directly for their services,” she said, adding there are very few unenrolled doctors across the country.
“If it can be confirmed that patient charges exist within a province or territory, a mandatory dollar‑for‑dollar deduction from the Canada Health Transfer payments to that province or territory are required under the act.”
The Winnipeg woman said all she knows is she is in constant pain and has the money that could end her suffering but she would rather spend it here.
Had she known how long the wait would be when she went on the list prior to the pandemic in early 2020, she would have taken money from her retirement savings to pay for surgery elsewhere, she said.
“It hurts all the time… It’s a slow deterioration of the bone. I have bone on bone rubbing. I would definitely have got it elsewhere if I could travel. For the price of a car I could get two knees done and no longer have this pain. I could then do what I had planned to do in retirement,” she said.
“You just get so tired of it.”
Kevin Rollason is one of the more versatile reporters at the Winnipeg Free Press. Whether it is covering city hall, the law courts, or general reporting, Rollason can be counted on to not only answer the 5 Ws — Who, What, When, Where and Why — but to do it in an interesting and accessible way for readers.