The Saskatchewan Ministry of Health website has a diagram showing the ten steps patients take on their path through diagnostic imaging in the public health care system. I decided to take a different path.

During an appointment with my family doctor I told her that I was willing and able to leave the province to access a diagnostic tool called a Magnetic Resonance Imaging (MRI) scan. I found a private clinic in Vancouver, British Columbia, where I could pay directly for the scan. My doctor wrote a referral and the clinic scheduled my appointment within a couple of days. I received an electronic copy of the scan before I left the clinic and the results of the scan were emailed to my doctor and me two days after my appointment.

Here’s why I didn’t choose the public health care route:

Only a specialist can order an MRI scan in Saskatchewan. Your family doctor has to refer you to a specialist. You could spend a few months waiting on a list for a specialist appointment. The specialist then sends the order for the MRI scan to a central booking office. The MRI radiologist reviews your medical history and assigns you an urgency classification level based on government guidelines for prioritization. Consideration is also given to the availability of hospital resources as well as other surgical and emergency cases.

Cheaper imaging tools must be used before allowing the more expensive MRI scan, as the guidelines for patient prioritization state “In general, other appropriate, more accessible and less expensive imaging examinations will be required prior to considering the MRI request. The MRI radiologist should review these studies prior to assigning a priority.”

Wait times for MRI scans in Saskatchewan are posted on the Ministry of Health website. As of December 31, 2011, there were 4,317 patients waiting on the list. Wait times are now reported as certain percentages indicating the number of scans completed within a certain number of days. These numbers are only updated quarterly. Also, keep in mind that health authorities can use various data collection and reporting methods. This wait time information is essentially useless for patients trying to figure out when they will have access to MRI.

There are no guarantees for wait times but not to worry, the government is balancing the needs of the population within the limits of a public health care system. As the guidelines state “The wait times suggested for MRI studies in the prioritization guidelines are the recommended maximum wait times for patients with the conditions listed, based on what we feel is an appropriate balance between limited access and patient need. The actual wait times for patients may be different depending on demand and availability of scanning time.”

Who really knows how long you’ll wait for an MRI scan in the public health care system? What impact will wait times have on your health and quality of life? When they do call your number, can you choose a day and time that’s convenient for you? Can you choose which hospital to go to? Can you choose the state-of-the-art MRI scanner or will you be assigned to an old scanner? Do you get to make any decisions about your health care while travelling the public health care path?

My health belongs to me. I’m willing to do my own research, weigh the risks and benefits, make health care decisions and spend my own money on my own health care. I’ve found the path to patient-centred care and I’m going to keep following it.

The government of Saskatchewan is choosing 86 patients with multiple sclerosis from a pool of more than 650 applicants hoping for a spot in a US clinical trial for the Liberation Treatment. Since its debut in 2009, many Canadian MS patients have travelled thousands of miles and paid thousands of dollars to access this treatment in the United States, Poland and Costa Rica.

What about those unlucky Saskatchewan patients whose numbers don’t get called? It’s more than luck preventing them from accessing the Liberation Treatment in their home province. It’s a health care system that gives politicians and health care bureaucrats the final say on which medical treatments patients can access.

Today it’s about medical treatment for multiple sclerosis patients. Tomorrow it could be about you and your medical treatment. What if the political spotlight doesn’t shine on your disease or condition? What if our politicians and health care bureaucrats don’t call your number?

BINGO!

Patients who don’t have time to play games with their health would be wise to push for a tax refund so that they can spend their own money on their own health care within their own province.

The Canadian government talks a good talk when it comes to preventative health care but let’s face it, in order to be preventative it has to be timely. My husband Cameron lost his father to esophageal cancer last year. With a family history of cancer and symptoms of heartburn he decides to see his doctor about having an endoscopy.

In January 2010 he visits his doctor and is referred to a specialist. He waits three months for the appointment where the specialist tells him that he will now be placed on a waiting list for an endoscopy. Cameron asks about getting one done privately but is told the option is not available in Saskatchewan. However, if he is willing to travel outside of the city his wait could be reduced. Apparently, the specialist travels to Rosetown, Saskatchewan, a couple of days each month where he has access to equipment for the procedure. Cameron agrees to travel and is placed on the waiting list for an endoscopy.

A couple of months later he calls the Rosetown & District Health Centre to see where he is on their list. A return call indicates that his appointment may be scheduled for some time in December which is more than five months away. In November he calls again and is told that the waiting list is now “horrendously long” and that his appointment may not be until January 2011. Gee, it’s pretty bad when all you want for Christmas is an endoscopy.

I contact a private clinic in Vancouver, British Columbia, to inquire about purchasing this health care service. I ask their patient care coordinator if she is aware of any private clinics closer to Saskatchewan. She tells me that many Saskatchewan patients are coming to their clinic. I soon understand why they are heading out west. The clinic offers a package that includes a consultation with a Gastroenterologist, endoscopy, biopsy (if required), and a copy of the report and lab results. Unlike the public health care system, they treat you like a real customer and provide information on costs. The price for an endoscopy package at the private clinic is close to $2,000. I make some quick calculations – the price to see a movie at the theatre is about $50 which includes babysitter payment, admission, and snacks. A dinner out can cost around $100 and includes a drink, main course, and dessert. The grocery bills in any given month add up to at least $500 and the annual license plate registration for my car costs more than $1,000. The peace of mind that comes from accessing a procedure that can help detect cancer in stages early enough for treatment is well worth its $2,000 price tag and, like most other purchases, a credit card can be used to pay for it. If only this option were available in Saskatchewan we could save a great deal of time and money on airfare and accommodations.  

I’d prefer to pay directly for health care services instead of throwing my federal and provincial tax dollars into the financial black hole of Medicare where politicians and health care bureaucrats make decisions regarding my access to health care and the type and quality of care I’ll receive.

A day after making the appointment at a private clinic Cameron receives word from the centre in Rosetown that his endoscopy is now booked for the third of December. He’s been bumped up the list (read my previous post on how to be a queue jumper). The appointment is just two weeks away and a one hour drive is much easier than a trek to another province. He chooses to have the procedure done closer to home. It’s his health and his choice so I agree to cancel the appointment in Vancouver.

On the morning of December 3, we drive to the Rosetown & District Health Centre. After checking in with the front desk we are directed to the waiting room. They should have said hallway. A number of chairs line the walls near the end of a long hallway. Patients in hospital gowns fill the seats along with their accompanying family members. They inform us that the doctor is running a couple of hours behind schedule. I can’t help but notice a large crack running across the hallway floor and find it to be a fitting metaphor for our health care system.

If all you want for Christmas is an endoscopy, then perhaps you should consider buying one. It may just turn out to be the gift of a lifetime.

The Saskatchewan government recently entered into a contract with the Omni Surgery Centre in Regina and is now finalizing one with the Saskatoon Surgicentre to provide a certain number of day surgeries for patients in the province. The contracts are good news for some of the 26,915 Saskatchewan patients currently on waiting lists in the public health care system.

Both private facilities already perform surgeries on patients belonging to groups that fall outside of the public health care system, such as the provincial Workers’ Compensation Board, and patients paying directly for services not publicly funded.

The provinces of British Columbia, Alberta, and Ontario often contract with private facilities to deliver publicly funded health care services. Lower overhead costs and the option of using non-unionized employees enables many private facilities to provide timely access and cost-effective services.

Unions representing 25,000 health care workers in Saskatchewan including the Canadian Union of Public Employees (CUPE) Health Care Council, the Service Employees International Union (SEIU), and the Saskatchewan Government and General Employees Union (SGEU), reached a tentative agreement with the government in August. Their contract, which comes into effect after ratification by union members, includes wage increases and retention of their extended health benefits plan. 

The CUPE Health Care Council plans to protest the new private surgical contracts claiming that patients can receive surgery at public facilities out of province for less money. It is interesting to note that unions are protesting the surgical costs for patients at the same private facilities to which their own members are provided expedited access through workers compensation.

Perhaps if these unions were to consider some of the additional costs borne to patients on surgical waiting lists, like deteriorating health and quality of life, they would be more supportive of this small step towards “putting patients first” in Saskatchewan.

Last year, media reports kept us abreast of the people jumping Canada’s health care queues for the H1N1 vaccine. Among those making the list were hospital board members and donors and professional athletes and their families.

Many Canadians voiced their anger over these individuals receiving the vaccine ahead of priority groups identified by the government. This anger increased when some public vaccination clinics were forced to close for a period of time after public demand exceeded government supply. It was interesting to watch this reaction considering that queue-jumping in our public health care system takes place every day across the country.

Individuals belonging to certain groups including Canadian Forces, RCMP and federal inmates are provided with coverage under separate federal programs outside of Medicare. This means that these individuals can legally access “medically necessary” services at private facilities. This advantage is also enjoyed by recipients of provincial and territorial workers’ compensation. Outside of these groups many Canadians use their celebrity, community status or personal connections to help them jump the queues.

The claim that Canada’s public health care system provides equal access to health care for all of its citizens is untrue. What is true is that when your life or the life of someone you love is on the line, you may need to jump a public health care queue.

There are currently legal cases in British Columbia, Alberta and Ontario challenging provincial laws prohibiting Canadians from purchasing private health care insurance and medical services. These court cases will take years. In the meantime, here are some tips I’ve learned from patients on how to be a queue-jumper in Canada’s public health care system:

• Call often when awaiting test results or for updates on cancellations and appointments with specialists or for surgery. They will try to tell you that you must wait ‘like everybody else’. Remind them that you are an individual which means that you are different from everybody else.
• Network to find someone who knows someone, preferably a list-keeper, who can help move your name up the list. It happens more often than you think!
• Check with your employer group health insurance plan to see if they provide coverage for any diagnostic imaging or second opinion services by medical specialists.
• Use the Internet to help locate private facilities offering diagnostic imaging and pay for any tests needed by your medical specialist. These places are prohibited from providing services without a physician’s referral but check to see which other health care practitioners in your province or territory can provide referrals. 
• Go to the hospital by ambulance. It may cost you a few hundred dollars but you’ll have a better chance of getting an MRI or CT scan more quickly.
• Have your family doctor send a referral to a few specialists, located in different provinces or territories if necessary, and make appointments with all of them so that you can take advantage of any cancellations and take the first available appointment.
• Keep seeking care through the emergency department while waiting for surgery. If you visit enough times your case may be considered more urgent.
• Contact the media and go public with your situation. As one of the top issues in Canada, stories about our health care system receive attention and regional health authorities prefer to avoid negative publicity.
• Hold a demonstration outside of your provincial or territorial legislature. 
• Recruit family and friends to become advocates for you and help discover any loopholes available in your local health care region.

Queue-jumping can take time, so depending on your medical condition your best option may be to follow the lead of Canadians who leave the public health care queues to seek medical care outside the country. Many hospitals have staff dedicated to assisting Canadian patients and often accept major credit cards or provide discounts for a cash payment in full.

If given the opportunity, would you jump a health care queue? Let’s take a poll.

Perhaps you are a relatively healthy person and therefore feel little need to concern yourself with the plight of patients and doctors featured in news headlines across the country. Like a majority of Canadians you tend to believe that when you have a serious injury or illness that our health care system will provide the best medical care to ensure the best possible outcomes and quality of life. For you have listened to our politicians and complied with your tax obligations to pay for Medicare, a social program touted as part of our national identity.

Aside from the troubles of finding a family doctor or waiting weeks for an appointment with them, your minor ailments are usually addressed. Of course the wait is much longer if you require certain tests, a medical specialist or surgery. Waiting lists are a cornerstone of our government-run health care system. Politicians often help to normalize the existence of these health care queues by leading people to believe that their waiting is contributing to some social good.

On July 1, 2010, Ann Reynar’s waiting came to an end. She passed away at the age of 66 from colon cancer. After receiving a diagnosis of stage 4 colon cancer in early May, the Alberta resident was told to expect a call for an appointment from the Cross Cancer Institute in Edmonton. Unbeknownst to patients on the Institute’s waiting list, their names were being prioritized into two categories. The first category contained names of patients whose treatment offered a chance for survival and the second contained names of patients whose treatment may only prolong their life. Ann Reynar’s name was placed in the second category along with a number of other patients. By the time the call for an appointment came six weeks later, she was too ill for treatment.

At first a shortage of oncologists was to blame but then a letter written by Dr. Heather-Jane Au, an oncologist and former employee of the Cross Cancer Institute, appeared in the local newspaper and brought to light issues with working conditions and government funding.

An increasing number of patients and doctors are using their voices to inform others about the realities of Canadian Medicare. It is a health care system built on good intentions which, in reality, have remained mostly that. Yet we continue to trust in our politicians whose actions bring consequences that fall far beyond the scope of their political careers. And we continue to provide financial rewards indicative of success to our health care bureaucrats while patients and providers are left to deal with the failings of Medicare.

There is a need for you to be concerned about the Canadian health care system. More importantly, there is a need to be prepared for the moment you are placed on a waiting list for medical care; a moment when you must ask yourself – What am I waiting for?

The government of Alberta is feeling the heat after halting bankruptcy proceedings against a private surgical facility in Calgary. The Health Resource Centre (HRC), owned by Networc Health Inc., performed about 1,000 orthopaedic surgeries for the government in 2009. Anticipating future increases in its government surgical contract, the HRC entered into a lease agreement with the Cambrian Group of Companies for space in its new Cambrian Wellness Centre. A tenant and landlord dispute arose when Networc Health, Inc., tried to renegotiate its lease after learning that the forecasted surgical numbers may not be met.

Many provincial governments contract with private facilities to deliver publicly funded medical services due to their ability to provide timely and efficient care. Alberta Health Services (AHS) does not currently have the capacity to perform the surgeries originally slated for the HRC. To avoid adding more patients to its already lengthy waiting lists, the government decided to change its status from a customer to a creditor by paying off $1.3 million worth of bank claims against the facility’s cash flow and assuming its monthly rental fees. Its new secured creditor status enabled AHS to stall bankruptcy proceedings and file an application with the Court of Queen’s Bench for interim receivership by PricewaterhouseCoopers, Inc., which the Court granted until January 15, 2011. By this time the AHS expects to gain surgical capacity with the expansion of its Foothills Medical Centre in Calgary.

In addition to its contract with the HRC, the Alberta government allows the facility to perform a set number of surgeries on patients who are exempt from its provincial health care insurance program. These patient groups include those covered by Workers’ Compensation, federal employees, members of the RCMP and Canadian Forces, federal prisoners and foreign refugees. All other patients are forced to wait in the public queue as Albertans are legally prohibited from both purchasing private health insurance coverage for publicly funded services and directly paying for them.

Alberta Health Services prides itself on being the largest health organization in Canada and the largest employer in Alberta. The situation with the Health Resource Centre serves to illustrate the problems that arise when government monopolizes the role of paying customer. Under this type of health care system the survival of private facilities, like many patients, is dependent on government. 

A reasonable forecast can be made regarding the HRC and the private delivery of publicly funded services in Alberta. The number of surgical contracts between government and private facilities in Alberta and throughout Canada is destined to increase as the problems in our public health care system can no longer be considered a private matter.

10) You want to outshine the North Koreans and Cubans.

9) You really won’t lose your Canadian Identity. We didn’t invent single-payer, universal health care. We adopted the system from Great Britain.

8) The politicians, health care bureaucrats, and care providers telling you to “wait your turn” in the queue will most likely never personally experience one.

7) You decide that you’re not “like everybody else”. Your medical needs are unique to you. Unless you have an identical twin with identical medical needs, there is no one like you!

6) You agree with Chief Justice Beverley McLachlin of the Supreme Court of Canada that “Access to a waiting list is not access to health care.”

5) You realize that “patient wait times guarantees” vary across Canada depending on where you live and the priority areas chosen by your provincial or territorial government.

4) The data on wait times can be inaccurate thus leaving you with no true indication of exactly when your number will come up or how long your wait could last.

3) Your health and quality of life may deteriorate while you are waiting thereby making you ineligible for certain treatments or resulting in irreversible damage.

2) You can increase your chances of becoming a survivor.

1) It’s your health and it’s your choice.

When you think about our universal health care system do you ever wonder about the fairness of waiting lists, otherwise known as queues? Our politicians claim queues provide Canadians with equal access to health care. Do they really?

Remember the recent outcry when hockey players and their families jumped the queue for the H1N1 flu vaccine? I don’t understand why that caused such a stir because athletes, like politicians, always receive preferential treatment. Do you honestly think that any of them wait months on a list for an MRI or surgery? 

How can you be considered a queue-jumper if you are never really in the queue to begin with? In 2007 former prime minister Jean Chretien discussed his medical symptoms while playing a round of golf with a Cardiologist. He received testing the next day that revealed arterial blockage. Media reported that a cardiologist then requested emergency quadruple heart bypass surgery for the following day. This swift access to testing and surgery helped prevent heart damage from occurring. The Montreal Heart Institute denies that Chretien received any special treatment indicating that all of their patients receive the same standard of care. Oh, really? How many other patients are able to schedule their emergency surgery? On December 11, 2007 Chretien appeared on the CBC television show The Hour with George Stroumboulopoulos.

In the first two minutes of the interview we learn that after receiving the results of his tests Chretien was told that he would need surgery at some point in the future. His response was that he’d like to have it right away and they agreed to perform it the next morning. When asked why he didn’t have to wait on a list like everybody else he attributes it to luck. The truth is that luck has very little to do with it.

While on the campaign trail in 2006, the media reported that New Democratic Party (NDP) leader Jack Layton received a hernia operation in the 1990′s at the Shouldice hospital, a private facility in Toronto. An interesting choice for such a fierce defender of the public health care system. Then again, if labour unions helped found your political party then I suppose you are beholden to them politically not personally.    

The truth is that universal health care and its queues do not provide each of us with equal access when it comes to caring for our health. In a 2005 judgment, the Supreme Court of Canada confirmed that “Access to a waiting list is not access to care”. The shameful part is that politicians continue to shape our health policy and promote a public health care system whose shortcomings they will never experience.