Coverage for eye surgery just makes sense

Opinion

Hey there, time traveller!
This article was published 29/10/2024 (325 days ago), so information in it may no longer be current.

Canada’s medicare system requires that provincial governments pay for “medically necessary” health-care services. In exchange for that, provinces receive tens of billions of dollars each year from the federal government to help cover the cost of those services.

This year, the provinces will receive $52 billion from the Canada Health Transfer. Manitoba’s share is nearly $1.9 billion.

Not all health-care services are deemed “medically necessary” and each province is left to decide what is and what is not covered under its respective insurance plan. However, there are some procedures that are essential and should be funded by all provinces.

One of those is called non-invasive corneal collagen cross-linking (CXL), a potentially sight-saving surgical procedure to treat a progressive disease known as keratoconus. It can cause the cornea in the eye to thin and bulge into a cone shape and cause blurred vision. Left untreated, it can lead to legal blindness. The disease occurs in about one in 1,000 people.

CXL surgery strengthens corneal tissue and prevents bulging through the use of vitamin drops and UV-A light. However, the procedure costs up to $4,000 and is not fully covered by Manitoba Health. Patients who require the surgery are left to pay for most of it out-of-pocket.

Ophthalmologists and Doctors Manitoba (which represents physicians) have been lobbying the provincial government for years to cover the procedure, but to no avail.

“It is not like a cosmetic procedure,” said Dr. Gdih Gdih, a glaucoma and anterior segment surgeon in Winnipeg, who is also spokesman for the Canadian Ophthalmological Society. “This is like any other essential surgery needed, except that it is not as common as glaucoma or retinal detachment surgeries, which are covered for all patients.”

CXL surgery is covered in half the provinces – British Columbia, Newfoundland and Labrador, Nova Scotia, Ontario and Prince Edward Island – but not Manitoba, which until recently considered the surgery to be experimental. The province does not cover procedures it deems experimental, part of a clinical research trial or an emerging treatment not yet proven to be effective.

However, CXL does not fall into any of those categories and the Manitoba government no longer considers it experimental.

“It should really be a slam-dunk as far as coverage,” Dr. Jeremy Levi, a Winnipeg specialist who performs dozens of procedures each year, said. “It’s long overdue.”

Manitoba Health offers limited coverage for the procedure: $613.06 for both eyes. That means patients are left to pay the rest. At a cost of around $2,000 to $4,000, some Manitobans are forced to shell out around $1,400 to $3,400 for what is clearly a medically necessary procedure. That seems inconsistent with the universal coverage principles of Canada’s medicare system.

Many individuals and families cannot afford to pay those kinds of medical bills, which is precisely why we have a medicare system, so that people are not denied access to essential medical care based on their income.

Besides, left untreated, keratoconus can worsen and lead to more complex and costlier surgeries, such as corneal transplants, which are covered by Manitoba Health. Even from a purely financial standpoint there is a strong argument in favour of covering this procedure.

There is some hope that Manitoba may now be willing to reconsider its position on CXL. After inquiries by the Free Press about why it does not fully cover the procedure, the provincial government has invited Doctors Manitoba to discuss the possibility of including it in its insurance plan.

That process should be expedited. Manitobans should not have to pay out-of-pocket for medically necessary health care services.