Tuesday, September 15, 2009


By Ellipses

Refugees and wait times. They are like peas and carrots in the health care debate pot-pie. Always present, seemingly important, often cited but never achieving the spotlight that one would expect of the prime argument against socialized health care. Refugees and wait times are like Taylor Swift and Kim Clijsters; deserving of their time in the sun as opposed to just being the prop for Kanye and Serena’s jackassery.

Let’s start with the hoards of health care refugees who seek care in the United States because ours is the greatest health care system that God has given man and we should be thankful for $13,000 premiums and 77 year life expectancies. After all, if we weren’t the Lil’ Wayne of health care (most awesomest evah!) then we wouldn’t have this constant deluge of Canadians bearing down on us from on high upon our northern border in search of magic treatments and overpriced pharmaceuticals, right?

You see what they do, there? The question gets posed about WHY all these people come here for health care, rather than asking the primary question of DO all these people come here for health care?

Seriously, how many people ACTUALLY come to the United States, from Canada, explicitly for health care?

Luckily, we have an extremely thorough dual-perspective study of this phenomenon conducted by Steven Katz that finds that Canadian Health Care Refugees are “more myth than reality.”

First, let’s look at the methodology of the study. I said it was “dual-perspective” which means that they polled Canadian citizens to ask them specifically if they had received medical treatment in the United States in the past 12 months. Then, they polled a sample of U.S. hospitals in population areas bordering Canada and asked how many Canadian patients they had treated in the past 12 months. Each data set would be used as a counterweight to the other. The “perception” of influx from the US could be compared to the reporting of egress from Canada to see if either side supported the others claims regarding patient traffic.

First, let’s revisit the argument by “the right.” From Katz’s study: “American opponents of universal public coverage have argued that global constraints on capacity and funding force many Canadians to cross the border in search of services that are unavailable or in short supply in their own country.”

This is how the “Canadian Perspective” data was collected: 18,000 Canadians were polled (overkill) and asked “In the past 12 months, did you receive any health care services in the United States?” If the respondent answered in the affirmative, they were asked this followup question: “Did you go there PRIMARILY to get these services?”

The reason for this sequence of questions is that thousands of Canadians routinely visit the US for business travel, leisure travel, incidental travel, or they own a residence in a warmer climate. In the course of these regular visits, they could need incidental care. A goose could fall off a Segway in Myrtle Beach and need to go to the hospital, for example. This overlap requires some specificity about the nature of the visit and if seeking health care services was the prime motivator.

The results? One half of one percent of respondents reported having received medical treatments in the United States. Of those people, eighty percent of them did NOT travel to the US specifically for health care. Only one tenth of one percent of respondents went to the United States specifically for health care services.

Included in that one tenth of one percent figure were people that sought cosmetic surgery in the United States (breast implants, face lift, tummy tuck, etc), as well as people that live closer to a US population center than they do to a Canadian population center, where the Canadian government specifically contracts with US providers for certain services. For example, Windsor had an agreement with hospitals in Detroit to receive gunshot victims because of Detroit’s unique experience dealing with injuries of that nature.

Alright, so one tenth of one percent… what’s that look like from the US side of the border? Forty percent of health care facilities polled reported treating zero Canadian patients. Forty percent had treated fewer than 10. Fifteen percent treated between 10-25 and 5 percent treated between 25 and 100 Canadians. 80 percent of health care facilities that would be reasonably accessible to Canadians (located in border states) treated fewer than 10 Canadian patients in the past 12 months.

Over a five year period, 2,031 Canadian patients were admitted to Michigan hospitals, 1,689 were admitted to New York hospitals and 825 were admitted to hospitals in Washington state. In that same 5 year period, the bordering provinces that those patients presumably resided in saw patient traffic of 1 million, 600,000, and 350,000, respectively.

In the case of refugees, there just isn’t any “there” there.

Now, the issue of wait times. In Canada, treatments are queued based on the necessity of timeliness so that procedures that have a higher efficacy rate when performed quickly (time of the essence) get performed quickly, while procedures that do not need to be performed immediately have longer wait times. The result is a rational distribution of procedures based on severity of the condition.

Indeed, though, the wait times in Canada ARE greater than that in the United States, on average. However, England, Germany, Australia and New Zealand beat the US on wait times.

On the issue of breast cancer treatment wait times, specifically, Canada averages an 8 week wait time. The range of integers that figures into that average are 80% distributed between “immediately” for dire cases to 12 weeks for non-emergency treatment.

This works out to the average wait time of 8 weeks.
When you compare that to the breast cancer treatments in the U.S., the wait times are not distributed due to severity of the illness, but rather, by quality of coverage and ability to pay. As such, the majority of treatment times, for those insured, are massed on the “immediate” end of the timeline, while those without coverage or a general inability to pay for coverage delay treatment, with some not receiving it at all. This is NOT due to provider refusal to provide coverage, but an unwillingness to seek treatment that one cannot pay for. There is plenty of anecdotal evidence of people receiving treatment despite being unable to pay for it, but the real-world results show people putting off treatment while they attempt to buy coverage or locate a funding source.

Because of the immediacy of treatment among those without the burden of finding coverage or funding, the average wait time for breast cancer treatment in the US is lower. However, the distribution of that treatment is hardly equitable or even rational, in terms of the effect of immediate treatment of tumors contributing to increased likelihood of survival.

For my next trick, I plan to shine a flashlight under Sean Hannity’s bed to prove there aren’t any socialist monsters hiding there. Go to Iconoclast, Part Deux Sphere: Related Content


Cylinsier said...

Great post.

Ellipses said...

Awe, tanks! :-)

Ondinita said...

Wonderful post!!! More ammunition for my healthcare debates!!! LOL
BTW, my mom was one of those people that didn't get breast cancer treatment immediately bc she didn't have insurance or the money to pay for it...She battled cancer for 7 years and eventually passed away. She was only 50 yrs old...