In the US, medical costs come in the form of drug prescriptions, doctors visits, expensive surgeries, and visits to specialists. As originally reported in The Tyee,
in Canada, patients are lucky: all of that is covered by the provincial governments. For Michael Rawluk’s case, that means British Columbia. However, these aren’t the only hospital related costs. Costs of disease come from more than just the medical visits themselves. Transportation and living expenses must be taken into consideration as well. These costs add up when one requires healthcare professionals that are only available in bigger hospitals.
When Did Transportation Become a Problem?
B.C. used to be better about this; transportation was not always the problem it is now. The problem was caused by a change in law in 2001 that changed the provision of medical services. Health care that had once been spread over the region in 52 facilities was now packed into six regional authorities and one provincial. This relocated many health services into urban centres which have steep living and housing prices and often require families to pay for both their normal home and this satellite location. In turn, many residents must travel to these cities to get access to care that was once spread across less expensive locations.
The Financial Burden on Patients
This means that for many patients, accessing medical care means paying for hotels, renting homes, taking time off work, or affording longer term housing in the city in additional to their normal home. This can be difficult if you already are paying for your mortgage and now need to take on a second rent in Vancouver. Couple Michael Rawluk and Kim Herdman experienced this when Rawluk’s treatment was in the city, which is 550km from their home in Williams Lake;they needed to stay close by for a few months. This mean they had to pay for both their regular bills at home and the second set in the city, causing them to dip into their savings and retirement. Others simply cannot afford to take on both, and do not have saving to make use of. Some sell their homes, remortgage, take out loans, or live close by in tents. Jude Kornelsen, director of the Centre for Rural Health Research at the University of British Columbia, says that expectant mothers frequently travel over 100km when giving birth, forcing families to come up with travel solutions that are often costly and inconvenient. However, despite the difficulty posed by the need to relocate to an expensive urban centre, there is not yet sufficient research or data on these travel costs.
For patients with rare diseases, this is particularly relevant. Rare diseases often require access to specialists that are only in the most advanced medical centres as well as more frequent and complex treatments. Rarely does someone with a rare disease get to visit as a once off; rather the daily life and the hospital can be intimately tied. These expenses stack up if one must routinely visit expensive cities and spend time in hotels or housing there.
British Columbia’s Travel and Accommodation Assistance
In British Columbia, residents are not entirely without travel assistance. The province has a Transportation Assistance Program provided by the health ministry that covers air travel or ferries for non-emergency travel, though not for car costs, housing, food, or other living expenses. Health Connections is another program which helps subsidize travel expenses, providing bus subsidies and access to non-profits such as Wheels for Wellness, which provides rides for patients to medical appointments. There are additionally health related social workers which assist patients with accessing funding or resources if available and alert them to hotels may have discounts for those visiting for medical reasons. These resources help cushion the expenses and do not leave patients completely alone to figure out their related finances.
There are additionally some housing options available. For example, the Ronald McDonald House provides 72 bedrooms for families with children receiving medical care there, with shared kitchens, some free meals, and washers and dryers. However, there is only space for a small portion of the people traveling. For patients with rare diseases, medical visits are often more common and require more regular travel. Rather than needing facilities only for the duration of a disease or for a few weeks at a time, they need it over months and years. Additionally, not every patient qualifies for these services and even when eligible there are simply not enough options available to cover everyone.
Kornelson is now conducting a study on medical related travel expenses, but does not yet have results or conclusions, only the stories being told by patients. While not every expense can be sorted, ultimately the system should be designed to provide equal access without neglecting the population outside the cities.