Far from being a kind of "medical tourism," the practice of treating overseas patients in Ontario hospitals - including those from war-torn countries - is proving to be a blessing for Ontario's health system, creating more beds and services for all, an advocate for the system says.

With the help of the federal government, the University Health Network (UHN) in Toronto has been bringing Libyans injured in their country’s civil war to Toronto for treatment. Some require surgery, but most arrive in Ontario for outpatient treatment, such as rehabilitation and obtaining prosthetics.

Money for treatment has already been deposited in Canada.

The extra capacity, says Marnie Escaf, UHN senior vice-president and international co-lead, has allowed UHN to open an operating room and two new hospital beds in Toronto.

Those rooms and beds are occupied by Libyans only 15 per cent of the time, leaving the spaces open for Ontarians the remaining 85 per cent of the year.

“That is a really wonderful example of international patients coming into Toronto and helping us build capacity within UHN to give back to Ontarians,” says Escaf. “If we didn’t have that program then we would close that resource because we don’t have any other way to … fund that.”

Marnie Escaf, University Health Network Senior Vice President and co-lead of UHN International. (Photo submitted.)

Marnie Escaf, University Health Network Senior Vice President and co-lead of UHN International. (Photo submitted.)

It’s not “medical tourism,” as the practice of admitting international patients to the Canadian health care system for profit has been called. Rather, hospitals claim it’s the price of preservation and growth.

In Ontario, UHN has expanded the program in recent years and provides services through its Toronto General, Toronto Western, Princess Margaret and the Toronto Rehabilitation Institute sites. Sunnybrook Health Sciences Centre began a similar program earlier this year.

The province budgeted $50 billion for health care spending this year, but is limiting funding increases to 2.2 per cent annually over the next three years. The federal government is due to throttle back increases of Canada Health Transfer payments from six per cent annually to the average growth of the country’s economy by 2016-17. With this going on, hospital budgets have already been effectively paralyzed since 2012.

International consulting gigs and importing patients in need are just two of many ways to increase money for hospitals.

From January to June 2014, approximately 75 international patients were treated at UHN under its international patient program. Of those, 33 came from Libya and the other 42 came from 22 other countries – mainly from the Caribbean and the Middle East, says Escaf.

UHN has treated nearly 400 international patients at home since 2011. Their costs are often paid up front through a private insurance agreement, says Escaf.

The golden ratio, though, for UHN is that for every international case two more Ontarians must be treated. There are also three other fundamental principles for the international program: No Ontario patient can be displaced by an international one; all money received from the Ministry of Health will go towards treating Ontarians; and any money generated abroad will be reinvested into care back in the province.

UHN - whose former CEO Bob Bell is now Ontario's deputy health minister - doesn’t commit to any patient volume either.

“Because we have to have the flexibility to work within our principles,” Escaf says. “We are always looking for other revenue streams in healthcare and that’s actually not new and it's not just us."

The Princess Margaret Cancer Centre is in the fourth of a five-year, $100-million consulting contract with the Kuwait Cancer Control Centre (KCCC), after responding to a request for proposal. UHN’s team is helping the centre develop world-class cancer care, and is now seeking an extension to its contract.

But this isn’t supposed to hurt service on the home front. Before anyone from Princess Margaret is sent to Kuwait, Escaf says the hospital must have the ability to fill the vacancy left behind. Once gone, Kuwait has a publicly-funded healthcare system and UHN is reimbursed for the employee’s salary, usually at a higher rate than normally paid by UHN. Any left-over revenue is reinvested.

UHN, which also includes Toronto Western, Toronto General and the Toronto Rehabilitation Institute, benefits through the worldly experience gained by its employees as well.

“It’s really sort of a win, win, win,” said Escaf.

UHN is attempting to chase down more opportunities abroad. Escaf says they have been doing some preliminary cancer work with Hamed Medical Corp. in Qatar, where the Hospital for Sick Children has already helped build an entire pediatric hospital.

Such projects will “really enable us to maintain the level of service that we provide,” Escaf says.

In an open letter, nurses’ groups called for the government to end “medical tourism” as it undermines Ontario’s health care system. Health Minister Eric Hoskins responded to the nurses’ letter by saying his government is committed to protecting universal health care and that his ministry would review international patient programs.

Escaf says UHN’s principles show the allegations are “just not really based on fact in terms of how we actually run the program.” She added that their international program has had the blessing of the province. “They’re certainly aware of our principles and supported those."

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