Dr. Brian Day @DrBrianDay

Brian Day is an orthopaedic surgeon and founder of the Cambie Surgery Centre in Vancouver. He is a past president of the Arthroscopy Association of North America and of the Canadian Medical Association.

What if we could transform our most costly social program - health care - into a revenue generator? Outrageous as that may sound, I believe it is achievable.
Singapore, India and Thailand are among many countries that have recognized the potential of medical tourism. This new worldwide "industry" has doubled in size for the past three years, reaching an estimated $80-billion in 2008.

A 2007 report by Deloitte estimated that 750,000 patients left the United States to get health care abroad, a number that was projected to rise to six million by 2010 and 12 million by 2012. U.S. insurers are negotiating contracts with foreign hospitals, expected to be worth $162-billion (U.S.) by 2012.

Although the United States is our closest neighbour and biggest trading partner, virtually none of that revenue comes to Canada, despite the fact that we could significantly discount U.S. health prices. Most U.S. patients would surely prefer the option of being treated in Canada, and medical tourism could become our biggest industry.

B.C. is also well positioned geographically and culturally to attract patients from other countries. The creation of long-term, well-paying jobs and the benefits of investment in infrastructure, medical technology and research could well be the answer to the loss of some of our more traditional areas of international trade.

But there is a big barrier to that transformation: Canada's health system is stuck in a time warp from the 1960s. Governments have boxed themselves into a corner in health policy decision making. The World Health Organization has emphasized that if services are to be provided to all (universality), then not all services can be provided. Politicians are often loathe to make difficult but necessary decisions. Their application of rationing is often irrational and is based on four-year electoral (and financial) cycles that do not favour long-term planning. Sustainability is the buzz word in health economics, and, in B.C., has been added as a legal requirement in our Medicare Protection Act.

The economic impact of health care is the single biggest factor that will force reform in Canada and the United States. In the recent British Columbia election, the economy was the number one issue. Health care was way down the agenda. If, in our home or business, 43 per cent of our income were spent on a single entity, would we not give it a high priority? The Statistics Canada report that placed the annual economic cost of mental illness at $51-billion, or the Canadian Medical Association report that showed the economic cost of waiting in just four of the thousands of categories of illness and injury was $15-billion in a single year, are indicators of the economic impact of health.

The added pressures of aging baby boomers and expensive new drugs and technologies will continue. Recent headlines on budget overruns and plans to cut back on procedures in hospitals are the inevitable result of demand exceeding supply. This is despite the fact that from 2008 to 2010, 90 per cent of all new government spending in B.C. will be on health care. Nationally, health spending has risen to more than 10 per cent of GDP today from 6 per cent in the 1960s.

What are the solutions? Certainly, savings can be had through increased efficiencies. I favour some private sector competition for the government system. I have never known a monopoly that served consumers well. I support reformed financing for hospitals so that the money largely follows the patient (patient-focused funding). Some savings may be realized through prevention. However, our medical successes also lead to an aging population and increased health costs.

Reform is essential. Limited access, reductions in work force, restricted access to technology, long waits that negatively affect the economy and funding pressures cannot be ignored. We must stimulate competition, efficiency and accountability, and we must recognize the need for sustainability.

Canada must borrow from the best practices of the many countries (not the United States) that outperform us. We must encourage private sector investment - and international trade in medicine. This will allow us to maintain a system that is sustainable and in which no one is denied necessary care based on inability to pay.