• Meme-busting: Canadians regularly come to the US for care

    This is an ongoing series on health care system “memes” that continue to permeate our debate, even when evidence shows them to be false. The introductory post contains links to all entries.

    I’ve done this one before; it even won chart of the year from Andrew Sullivan’s Daily Dish last year. But I still get emails and comments asking me to tackle it. Evidently, it still needs busting. Too many still repeat the well used meme in the health care debate that people in other countries – frustrated by wait times and rationing – come to the United States for care.  These are almost always anecdotal stories and you should know by now how much stock I put in anecdotes.

    As always, when we can we should turn to evidence and research, and on this topic it does exist.  The most comprehensive work I’ve seen on this topic was published in a manuscript in the peer-reviewed journal Health Affairs.  That study looked at how Canadians cross the border for care.  Most anecdotes involve Canadians, since it’s easy for those on the border to come here.  And, the authors used a number of different methods to try and answer the question:

    1) First, they surveyed United States border facilities in Michigan, New York, and Washington.  It makes sense that Canadians crossing the border for care would favor sites close by, right?  It turns out that about 80% of such facilities saw fewer than one Canadian per month.  About 40% saw none in the prior year.  And when looking at the reasons for visits, more than 80% were emergencies or urgent visits (ie tourists who had to go to the ER).  Only about 19% of those already few visits were for elective purposes.

    2) Next, they surveyed “America’s Best Hospitals”, because if Canadians were going to travel for care, they would be more likely to go to the most well-known and highest quality facilities, right?  Only one of the surveyed hospitals saw more than 60 Canadians in one year.  And, again, that included both emergencies and elective care.

    3) Finally, they examined data from the 18,000 Canadians who participated in the National Population Health Survey.  In the previous year, only 90 of those 18,000 Canadians had received care in the United States; only 20 of them had done so electively.

    Here’s another way to look at that final statement:

    Look, I’m not denying that some people with means might come to the United States for care.  If I needed a heart/lung transplant, there’s no place I’d rather be.  But for the vast, vast majority of people, that’s not happening.  You shouldn’t use the anecdote to describe things at a population level.  This study showed you three different methodologies, all with solid rationales behind them, all showing that this meme is mostly apocryphal.

    Maybe that’s why the manuscript was titled, “Phantoms in the Snow.”


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    • Are there any peer-reviewed studies of the opposite phenomenon, that is, American use of the Canadian health care system? Americans certainly go to Canada for prescription drug purchases, and I sincerely doubt that Canadians come south of the border to stock up on cheap American prescription drugs. Perhaps uninsured or poorly insured Americans are traveling north to save money on medical procedures, too.

      • Perhaps uninsured or poorly insured Americans are traveling north to save money on medical procedures, too.

        Interestingly Dean Baker has suggested that the USA Gov. make a deal with Canada to care for people on medicare. Those that volunteer to accept Canadian to care get some money Canada makes a little profit and USA saves money.

    • Does Canadian Medicare cover medical expenses incurred by Canadians in the US?

      • Sort of… They will cover anything covered in your home province, but only at the rate they would pay if you were treated in Canada. That is often a great deal less than what is likely to be charged in the US. So you hear horror stories about Canadians popping down to Bellingham for an afternoon of shopping, only to come home with a medical bill for tens of thousands of dollars (or even more) due to some medical emergency.

        Having said that, additional travel insurance available privately is very inexpensive. In my case, it’s so inexpensive that it’s included in my extended health care benefits package from my employer.

        But being a cautious sort who travels a great deal, I’ve even purchased additional coverage on my own. I purchased it from BCAA, the AAA (triple-A, or auto association). I’m 56 years old, don’t smoke, control my blood pressure with medication, and take a daily antibiotic for acne and rosatia. (That’s just my basic health history so you can see where I stand in the “risk pool”.)

        My coverage includes unlimited trips each year for up to 30 days at a time, to almost anywhere in the world (excepting a few places like Iran, Libya, etc). It covers damn near everything — details at – up to $5,000,000 ($3,000,000 for pre-existing conditions.)

        My cost, after member discounts, is $68/year, +$20/year for the pre-existing condition coverage.

        So no, officially they don’t cover the entire potential cost of emergency medical care in the US, but the extra cost is so low as to be a non-issue.

      • Yes, but…Each province has its own plan and the U.S. is the same as Ontario or India. Here are B.C.’s rules (which will be different from other provinces).

        http://www.health.gov.bc.ca/msp/infoben/leavingbc.html#outsidebc

        Employer’s extended health insurance often covers employees who have to travel abroad (to which I can testify, having been copied on my hospital and surgeon invoices from the U.S. ).

      • No, it does not, at least not in BC, where I’ve lived. If Canadians want health insurance while they’re travelling abroad, they have to purchase travel insurance from private companies.

    • It is frequently claimed by critics of single-payer public health insurance on both sides of the border that such use is large and that it reflects Canadian patients dissatisfaction with their inadequate health care system. All of the evidence we have however indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border.

    • When my Canadian grandmother came to visit for a couple months, she paid about $480 to extend medical coverage to the US for less than a month. Either she didn’t shop around or it was extra high because she was about eighty years old. After the first month she just took the risk herself rather than keep paying so much.

      So my experience is that it is not cheap for a Canadian to buy coverage while visiting the US (incidentally, I am a Canadian who has lived 21 years in Canada and now about 24 in the US).

      When my parents come to visit from Canada they are terrified of not being covered every single day with extended coverage. They have heard the US horror stories, and those stories are true.

      I’ve given a lecture or two on these issues and my extensive lecture notes are posted online here:

      We are very much in agreement. Love the blog!

      Darrel