Detroit Free Press | August 20, 2009
By Patricia Anstett

Hospitals in border cities, including Detroit, are forging lucrative arrangements with Canadian health agencies to provide care not widely available across the border.

Agreements between Detroit hospitals and the Ontario Ministry of Health and Long-Term Care for heart, imaging tests, bariatric and other services provide access to some services not immediately available in the province, said ministry spokesman David Jensen.

The agreements show how a country with a national care system -- a proposal not part of the health care changes under discussion in Congress -- copes with demand for care with U.S. partnerships, rather than building new facilities.

Michael Vujovich, 61, of Windsor was taken to Detroit's Henry Ford Hospital for an angioplasty procedure after he went to a Windsor hospital in April. Vujovich said the U.S. backup doesn't show a gap in Canada's system, but shows how it works.

"I go to the hospital in Windsor and two hours later, I'm done having angioplasty in Detroit," he said. His $38,000 bill was covered by the Ontario health ministry.

Canada eyed in the health care debate
Dany Mercado, a leukemia patient from Kitchener, Ontario, is cancer-free after getting a bone marrow transplant at the Barbara Ann Karmanos Cancer Institute in Detroit.

Told by Canadian doctors in 2007 he couldn't have the procedure there, Mercado's family and doctor appealed to Ontario health officials, who agreed to let him have the transplant in Detroit in January 2008.

The Karmanos Institute is one of several Detroit health facilities that care for Canadians needing services not widely available in Canada.

Canada, for example, has waiting times for bariatric procedures to combat obesity that can stretch to more than five years, according to a June report in the Canadian Journal of Surgery.

As a result, the Ontario Ministry of Health and Long-Term Care in April designated 13 U.S. hospitals, including five in Michigan and one more with a tentative designation, to perform bariatric surgery for Canadians.

The agreements provide "more immediate services for patients whose health is at risk," Jensen said.

Three Windsor-area hospitals have arrangements with Henry Ford Hospital, Detroit, to provide backup, after-hours angioplasty. Authorities will clear Detroit-Windsor Tunnel traffic for ambulances, if necessary. The Detroit Medical Center also provides Canadians complex trauma, cancer, neonatal and other care.

"In the last few years, we've seen more and more Canadian patients," said Dr. J. Edson Pontes, senior vice president of international medicine at the DMC. They include Canadians such as Mercado, whose care is reimbursed by Canada's health system, as well as people who pay out of pocket to avoid waiting in Canada.

Pontes declined to give revenue figures for the DMC's international business, but said the program "always has been a profitable entity." About 300 of the DMC's 400 international patients last year came from Canada, he said.

Tony Armada, chief executive officer of Henry Ford Hospital, said the hospital received $1 million for cardiac care alone.

Critics of a health care system like Canada's -- a publicly funded system that pays for medically necessary care determined by provinces -- often cite gaps in Canada's care to argue that the United States should not allow its current debate over health care to move it to a socialized system.

No plan currently under discussion in Congress calls for a universal plan like Canada's, but opponents fear socialized medicine, anyway.

Canada's U.S. backup care "speaks volumes to why we don't need government to take over health care," Scott Hagerstrom, the state director in Michigan for Americans for Prosperity, said of the Canadian arrangements with Michigan hospitals. "Their system doesn't work if they have to send us their patients."

But Dr. Uwe Reinhardt, a Princeton University health economist who has studied the U.S. and Canadian health systems, said arrangements with cities like Detroit "are a terrific way to manage capacity" given Canada's smaller health care budget.

"This is efficient," he said. "At least in Canada, you don't worry about going broke to pay for health care. You do here."

Pat Somers, vice president of operations at Windsor's Hotel-Dieu Grace Hospital, one of the hospitals that sends patients to Henry Ford, said the issue of finding ways to pay for and prioritize care requests is not in only Windsor.

"The ministries are quite aware of" waits for care in Sarnia and Hamilton, she said. "That's why we are investing in a wait list strategy" to best determine how to prioritize cases for people who need hip and knee replacements, cataract surgery and treatment for cancer, for example.

Mercado, 26, faced a longer wait because he could not find a matching blood donor, even though his family conducted a broad search.

He said doctors told him money was limited for transplants, particularly ones using unmatched donors, which are riskier.

After his family's doctor wrote the Ontario ministry, the agency agreed to pay $200,000 for the operation.

The family, their church and Mercado's school, Conestoga College in Kitchener, raised another $51,000 to cover expenses going back and forth to Detroit.

"I think of this every day as a gift from God," Mercado said.