N OUVELLES Canadian “medicare refugee myth” debunked in major US study Canadians are not rushing across the strates that headlines about “medicare gests there has been a modest increase in border to purchase medical care in the refugees” are “a tip without an iceberg.” the number of people looking for treat- United States, a new study based largely Of the US ambulatory facilities sur- ment in the US. “We asked what per- on American data has concluded. In veyed, 40% reported seeing no Canadi- centage of their patients have gone to fact, the use of American medical facili- ans and a further 40% had seen fewer the US for help. The figure used to be ties by Canadians is “so small as to be than 10. 1% percent, and it has risen to 1.5%. barely detectable.” Only 5% of facilities had seen more Tiny, but significant.” The authors of “Phantoms in the than 25 Canadians in the previous year, Frustration with the current Cana- snow: Canadians’ use of health care ser- and the most frequent services accessed dian system fuels misperceptions about vices in the United States” — the article were diagnostic radiology and ophthal- better service across the border. Michael appeared in the May/June issue of Health mologic procedures, particularly Decter, a former deputy minister of Affairs, the most influential US health cataract surgery. health in Ontario, says funding cutbacks policy journal (www.healthaffairs The picture emerging from state during the 1990s meant waiting lists de- .org/freecontent/v21n3/s6.htm) — hospital discharge data was similar. veloped for some diagnostic services conclude that debate over the issue has From 1994 to 1998, 2.3 Canadians were such as MRI scans and for treatment of been driven by politics, not facts. They admitted to hospital in the 3 US states specific illnesses. drew this conclusion from a telephone studied for every 1000 admissions in the This led several provinces to sign survey of ambulatory care facilities in 3 neighbouring Canadian provinces. temporary contracts with US providers heavily populated US urban areas bor- Moreover, 80% of the stateside ad- to secure specific services, such as cancer dering Canada (Buffalo, Detroit and missions were prompted by emergen- treatment. Information about the Seattle) and from statewide hospital cies and pregnancies. Of Canadian ad- greater availability of such services in the discharge data from Michigan, New missions to US hospitals, only 14% in US was part of every waiting list horror York State and Washington State. Au- Michigan, 20% in New York and 17% story. But Decter, who now chairs the thor Steven Katz of the University of in Washington State were elective. board of the Canadian Institute of Michigan and his colleagues created a Dr. Michael Walker, executive direc- Health Information, points out that catchy label for the “phantom hordes of tor of the right-leaning Fraser Institute, availability doesn’t equal access. “Less Canadian medical refugees” by tagging acknowledges that demand for treat- than 5% of Canadians feel they are de- the notion a “policy zombie” — an idea ment in US institutions is limited. “We nied access to health care because of that is intellectually dead because there did a survey of US hospitals 10 years cost,” he argues. “The equivalent figure is no evidence to substantiate it but ago and heard that Canadians were not in the US is 24%.” somehow manages to live on because a significant percentage of their patient The medical-migration stories serve it is useful to certain powerful interest populations.” some people well, he adds. “Health- groups. Nevertheless, he insists that a Fraser system bashing is popular. This myth The study, funded by the Canadian Institute survey of 2700 Canadian physi- suits provider groups who want more Institutes of Health Research, demon- cians’ experiences with waiting lists sug- money and it suits policy-makers interested in floating ideas about privatization.” Decter says the Katz study raises the Tobacco warnings are winners interesting economic argument that contracts with US institutions to provide The European Commission is being asked to in- care for Canadian patients can be “a per- troduce the same types of graphic health warnings fectly sensible approach to dealing with used on cigarette packages in Canada and Brazil. patient queues” because they allow ser- Cancer Research UK and 6 other research groups vice shortages in Canada to be matched say the ads make smoking “less stylish.” A survey to excess capacity in the US. of Canadian smokers indicates the warnings work; However, such a practice is largely 43% of respondents said the warnings raised their unacceptable to providers and patients, concern about the health effects of smoking and and this means that politicians who 44% said they are now more motivated to quit favour or recommend it will likely face a (CMAJ 2002;166[1]:1453). The European Parlia- “chorus of accusations that the system ment recently voted to increase the size of warn- fails to meet the medical needs of their ings to between 30% and 40% of cigarette pack- constituents.” age surfaces and banned the use of terms such as “ ‘If it bleeds, it leads’ is media lore,” “mild” and “light.” — CMAJ Decter concluded. “ ‘Canadians staying home for health care’ is not a good headline.” — Charlotte Gray, Ottawa 524 JAMC • 3 SEPT. 2002; 167 (5).