PHANTOMS IN THE SNOW

Those needy hordes of Canadians pouring across the border in search of the kind of medical services their government-sponsored system fails to provide may be a lot less horde-like than previously believed. The results of a study described this month in the health care policy journal Health Affairs refute a major argument that long waits and poor technology drive Canadians to the United States for medical care.

Researchers for the study, called “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States,” checked hospital admissions in New York, Washington and Michigan, the U.S. states near the three most heavily populated Canadian provinces, and checked records in Canada for patients departing for the United States. They were responding to comments that one of the reasons Canadians can have a health care system much less expensive than the one here is that Canadians regularly travel south for treatment and, further, that part of the increased cost of care here is driven by these added patients.

This is an argument popular on both sides of the border from people who do not like the idea of the government overseeing health care. Blaming the government for all problems in Canada’s health care system is a popular pastime for insurance lobbyists whenever citizens gather to look at a single-payer system, as one legislative group is doing now in Maine.

The problem of Canadians going south for care, however, may not be any government’s fault because the problem may not exist. The researchers found the total number of Canadian patients, by procedure, actually measured only in the hundreds – a tiny fraction of the total – with 40 percent of the U.S. hospitals surveyed seeing no Canadian patients for the year studied, 1997-’98, and another 40 percent seeing 10 or fewer. One exception to this was specific contracts for certain procedures. Quebec, for instance, contracted with radiation centers in Maine and Vermont for treatment of patients with prostate or breast cancer, and about 1,000 of these patients were treated in 2000. These contracts helped perpetuate the idea that Canada could not care for its own citizens, but it is important to remember that these patients too made up a small portion of the total provincial population with these illnesses.

In brief, according to the study, “State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross-border care-seeking arguments.” Refugees from Medicare, which is what Canada calls its health care system to confuse Americans, “are not the tip of a southbound iceberg but a small number of scattered ice cubes.”

Stories about what may be occurring somewhere else along a very long border do not die easily, especially when organizations have a strong financial incentive to keep them alive. No doubt they will be repeated as the single-payer group in Maine completes its work. At least one study says the Canadians stayed home.