For nearly three years, Brandon Taylor lived in agony with a herniated disc.

The now 22-year-old Hamilton student and his father, Stuart, were told open back surgery at Brandon’s age could be dangerous.

The wait to see a specialist who could help decide treatment was up to a year, they were told.
The best the Ontario health system could offer was prescription painkillers.

 In August 2007, Stuart Taylor packed up his son and agreed to pay $28,000 in Florida for minimally invasive laser microsurgery.

The treatment worked for Brandon, now a fourth-year engineering student at McMaster University.

But father and son are embroiled in a bitter battle with OHIP to have the medical costs reimbursed.

The Ontario officials who decide whether out-of-country treatment should be paid by public health insurance say the Taylors broke the rules.

OHIP says they did not apply for pre-approval as required, and that the Florida surgery does not qualify as it is considered experimental here.

 “Every single person I have spoken to, except OHIP, says I did the right thing,” says Stuart Taylor, who mortgaged his house to pay.

The Taylors are not alone.

Long waits, unavailable procedures and poor physician access are driving record numbers of
Ontarians to seek treatment south of the border and sometimes overseas.

A Metroland special report on cross-border care shows:

•  A 450-per-cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a period of explosive growth in new technologies and therapies not covered or available here. The province agreed to fund 2,110 procedures or treatments in 2001, and 11,775 last year.

• Patient demand has created a new breed of health-system navigators, known as medical brokers, who find U.S. options for the growing number of Ontario patients who elect to pay for medical services south of the border themselves.

Medical brokers negotiate discount rates with U.S. centres to get Ontarians faster diagnostics, second opinions and surgery.

Brokers say that for every patient sent south by the Ontario government, there may be up to 10 others who go — and pay — on their own.

• Ontario’s spending on out-of-Canada medical services has tripled in the last five years. Payments in 2010 will balloon to $164.3 million, from $56.3 million in 2005. The province said in last month’s economic forecast it needs to increase health spending by $700 million to cover “higher than anticipated” OHIP costs, including services outside the province.

While out-of-country spending is a small part of the $11 billion OHIP pays for all patient services a year, the increase is significant, Ontario’s health minister says.

“Are we looking at ways to reduce out-of-country? Absolutely yes,” said Deb Matthews, who became health minister last month.

Matthews says her ministry is taking steps to improve services and access across Ontario so fewer patients will need to go to the U.S.

At the same time, though, the ministry continues to negotiate preferred rates for Ontario patient visits to U.S. health centres, the Metroland investigation shows.

• Ontario has become a major contractor — a bulk buyer — of American health services this year.

Since spring, the ministry has entered into funding contracts with U.S. hospitals, imaging clinics and residential treatment centres.

It has these “preferred provider” contracts in place with about 40 American medical providers now — and is accepting solicitations from others. Contracts cover diagnostics, cancer care, bariatrics and adolescent behavioural disorders. The ministry says the agreements ensure “more immediate services for patients whose health is at risk.”

It has declined to release details of any of the agreements.

• The province does not track the number of Ontarians who cross the border for care on their own, never seeking government pre-approval or reimbursement.

But major U.S. medical centres contacted by Metroland — including Detroit’s Henry Ford Health System and the Mayo Clinic — say both government-funded and private-pay patient lists are growing.

The Mayo Clinic, which sees about 600 Ontario patients a year, says top reasons include wait times and diagnostic evaluations “when they’ve exhausted options in Canada,” says Mariana Iglesias of the Minnesota-based clinic.

OHIP’s pre-approved funding program for out-of-country care is supposed to fill gaps in health care for high-risk Ontarians.

But patients who use the system express repeated concerns — about the time it takes to get OHIP approval, and to appeal if refused.

“I really believe they make it as difficult as possible,” says Janet Nancarrow of Ottawa who is preparing for an OHIP appeal hearing for her 34-year-old daughter, Lisa, who is taking part in a clinical drug trial at the Mayo Clinic.

Her doctors and family say the trial is her only option short of end-of-life palliative care. With no outside help, Nancarrow said, she had to research precedent cases, find expert witnesses and keep up with enormous paperwork — all while accompanying her daughter back and forth to Minnesota for treatments.

“They shouldn’t put families through this,” she said.

• Ontario continues to struggle with wait times. This month, almost 140,000 people are on wait lists just for CT scans and MRIs.

• Wait-time insurance policies have emerged as the industry caught on to public angst. While no industry figures exist to indicate the level of consumer take-up of the coverage, plans are available to reimburse costs of private treatment when policyholders are forced to wait more than 45 days.

Ontario says it has made strides to reduce waits for the priority procedures it monitors. But the Ontario Health Quality Council — which the ministry set up to review provincial progress — says more needs to be done.

“Many Ontarians still wait too long for urgent cancer surgery, MRI scans … and specialists,” the council says in its 2009 report.

Ontario NDP leader Andrea Horwath says the OHIP out-of-country surge has taken on momentum, and that government must stop the southbound flow.

“The government needs to reinvest the dollars that they’re shoving out the door to private providers of health care in the States, and invest that in providing services here at home,” she said.