Special Report

A Health Private Sector

AMERICANS ARE FLOCKING TO CANADIAN CLINICS THAT OFFER AN ARRAY OF SERVICES

Brenda Branswell April 3 2000
Special Report

A Health Private Sector

AMERICANS ARE FLOCKING TO CANADIAN CLINICS THAT OFFER AN ARRAY OF SERVICES

Brenda Branswell April 3 2000

A Health Private Sector

Special Report

AMERICANS ARE FLOCKING TO CANADIAN CLINICS THAT OFFER AN ARRAY OF SERVICES

Brenda Branswell

When 30-year-old Michigan homemaker Tina Robinson decided to have her breasts enlarged, she shopped around for doctors near her home in a Detroit suburb. But advice from her best friend led her much farther afield—to a plastic surgeon in east-end Montreal. Happy with the breast-implant surgery she received, the friend recommended Dr. Gérald Rheault. Robinson was initially hesitant to cross the border for surgery, but she and her husband drove 10 hours to Rheault’s office in January. She estimates her implants and travel costs exceeded $5,000, compared with quotes of more than $7,000 from doctors close to home. While the price was a bonus, Robinson says, she mainly decided it was worth the drive “because so many people that we know had been to him and they hadn’t had any problems.”

Crossing the border for medical treatment might seem like one-way traffic out of Canada. Ontario and Quebec send cancer patients to the United States for radiation treatment

because of bloated waiting lists. On an individual basis, some Canadians cross the border to privately run U.S. health services to avoid long waits in Canada. In Plattsburgh, N.Y., an hour’s drive from Montreal, gastroenterologist Sabine Hazan says about 10 per cent of her patients are Canadian, most of them seeking colonoscopies. “I’ve always been interested in taking care of Canadians,” says Hazan, who was raised in Montreal. “I see the way the system is and I think it’s a shame.”

But as controversy swirls around Alberta’s bid to allow private facilities to provide more services, a mini-industry of private clinics already thrives in Canada—in part because of their growing appeal to American patients. Those clinics operate, perfectly legally, beyond the scope of the Canada Health Act that regulates the public health system. Along with Canadians, thousands of Americans flock to them for laser eye surgery, slimmer tummies, bigger breasts and other procedures not covered by provincial health plans. Such clinics already operate in Alberta, where the legislation under discussion would let private facilities offer more complex procedures, for profit, and possibly necessitating an overnight stay.

In yet another rare category are clinics that may already be stretching the law. In Quebec, a spokesman for the provincial health insurance board confirmed last week that it is investigating two Montreal clinics regarding extra-billing practices. In one case, hospital-based surgeons acknowledged charging patients a “facility fee” of $400 an hour so they could rent

operating-room space in a private clinic to do procedures covered by Quebec’s medicare. If the allegations are true, said the insurance board’s Pierre Boucher, “our stand on this subject is that this is illegal.”

Meanwhile, the non-medicare clinics thrive as low prices, a favourable exchange rate and Internet Web sites help swell their client lists with Americans. Dr. Claudio De Lorenzi of Kitchener, Ont., president of the Canadian Society for AesI thetic Plastic Surgery, says increasing numbers of Americans ê have travelled to Canada for cosmetic surgery over the past § four years.

I Some of that traffic is drawn by active marketing cami paigns in the United States. Dr. Fouad Tayfour, for instance, f spends about $1 million a year on radio, television and print I advertising to lure Americans to his laser eye surgery business

in Windsor, Ont. But now, the Canadian Medical Protective Association, which defends doctors in malpractice suits, is about to formally advise almost 58,000 members not to advertise south of the border. “We’re concerned,” says association spokeswoman Françoise Parent, “about having our physicians open to a court case that could be tried in the United States.” Not only would they face the risk of higher judgments, but they would be ineligible for the association’s legal assistance.

The American influx is apparent in the spacious waiting room at Lasik Vision in Montreal. A bespectacled man from New Hampshire jokes with the American couple beside him about injecting money into the Canadian economy. Nearby in a darkened room, Dr. Avi Wallerstein performs laser refractive surgery to correct the vision of a young Upstate New

York woman who lies motionless on a table. The centre is one of 15 operated in Canada by Lasik Vision Corp., a Vancouverbased public company, which treated 23,000 people last year, half of them from abroad, primarily Americans.

Practised in Canada since 1992, when it was still rigidly controlled in the United States, the popular eye surgery corrects vision using lasers to reshape the surface of the cornea. In Fort Erie, Ont., across the border from Buffalo, N.Y., Dr. Patricia Teal performs the surgery on an almost entirely American clientele. The low Canadian dollar is “a huge factor,” she says. Bonnie Richards agrees. The 39-year-old homemaker recently drove three hours from her home near Concord, N.H., to Sherbrooke, Que., so she could shed the glasses she has worn since Grade 2. Richards knows of 10 people who have had their eyes lasered by the same Sherbrooke ophthalmologist. Back home, Richards says, the surgery would cost $6,600. She paid $1,900, including travel costs, for her Sherbrooke operation—showing a savings of $4,700. “It sounds awful when you tell people you’re going up because of the cost,” says Richards, “but basically that’s it.” Canadian plastic surgeons have treated small numbers of Americans for decades. Now, business is growing. Americans, primarily from neighbouring Michigan, make up about 70 per cent of the clientele for Dr. Ken Dickie in .« Sarnia, Ont. Most come for saline I breast implants, with surgeons re! porting that breast augmentation I is definitely back in vogue follow| ing the controversy over silicone! gel implants in the early 1990s. “It really has taken off,” says Dickie, who describes his practice as “a shining example of how Canadians can tap into the American marketplace.”

Then there are the more esoteric services. A majority of the 200 transsexuals that Drs. Yvon Ménard and Pierre Brassard operate on at their Montreal plastic surgery clinic each year are Americans. In Toronto, plastic surgeon Robert Stubbs sees many foreign clients for a variety of services, including genital enhancement—penis extensions for men and labia reductions for women. As for the future of his American clientele, says Stubbs, “I think as people are more connected to the Internet, that’s going to go up dramatically.” Vancouver plastic surgeon Kimit Rai also says the Internet has helped boost American business. But will U.S. practitioners simply cut their prices in the face of Canadian competition? Not according to Teal in Fort Erie. “American surgeons,” asserts Teal, “will never work as cheaply as Canadian surgeons.” E3