Grief, desolation and guilt are among the normal reactions for a parent who loses a child. Canadian resident Douglas Hitchlock has experienced all those emotions and more.
Hitchlock's daughter lapsed into a coma and died of a brain tumor in 1985. The tragedy occurred just days after she had a brain scan, which was delayed because Canada's diagnostic services are in high demand and short supply.
"I don't want to see anyone else go through the loss or hell I went through," Hitchlock declares.
So Hitchlock, a 52-year-old stockbroker, decided to create a new business to remedy deficiencies in Canada's single-payer healthcare system. He hopes his Toronto-based company, the Free Trade Medical Network, can prevent his experience from happening to others.
With the help of New York-based PPO MultiPlan, Hitch-lock's firm buys medical services from U.S. hospitals at wholesale rates, often discounted 10% to 40% or more from customary charges. They are then either resold ("re-priced" is the official term) to insurers who write disability or travel policies or to individual Canadians who otherwise may have to wait to get the same treatment in their own country. Free Trade charges the purchaser a fee equal to one-third the discount between the retail and wholesale price of the procedure.
Hitchlock declines to disclose details on revenues and number of patients treated, noting that Free Trade only began full operations last November.
He recently signed a contract with Thomas Cook, one of the largest travel insurers in the world. Although only a handful of referrals have come from that deal to date, Hitchlock estimates the contract could net $10 million in its first year.
MultiPlan is optimistic about the business Free Trade can swing its way.
"We're just starting with them, but it's a very good opportunity for Canadians to come through the system in the states," says Steve Golin, national sales director for CareAway, MultiPlan's managed-care subsidiary.
The 2,500 hospitals in MultiPlan's network are also grateful for the business, even if it's discounted, Golin adds.
"Any business the hospitals can get through their doors is appreciated, and their discounts are not going to be their actual cost anyway," he says.
Among the participating hospitals are University of California Los Angeles Medical Center, Cleveland Clinic, Mount Sinai Medical Center in New York City and other prestigious institutions.
The potential for treating Canadian patients in the U.S. is enormous, Hitchlock believes, particularly on the disability/workers' compensation end, where injured workers can wait months before being admitted to rehabilitation.
According to a recent survey by the Ramsay Institute, a Vancouver-based think tank, Canadians in late 1995 waited 10.2 weeks on average for referrals from general practitioners to specialists, up from 9.7 weeks in 1994. In some of the more rural provinces, such as Prince Edward Island, the average wait can stretch to three months or more.
"You're looking at three to four months for a (workers' compensation) case to receive treatment, with tens of thousands of dollars being spent on disability payments during that time," Hitchlock says. "Is it no wonder we have a 10% unemployment rate? It's better that the money be reinvested productively elsewhere."
Media exposure both in Toronto newspapers and the New York Times has generated many inquiries from individuals unable to get procedures in Canada in a timely fashion, Hitch-lock adds.
"Given all that's happening in Canada, the creation of companies like Free Trade is not a surprise," says Ken Weixel, who heads Deloitte & Touche's West Coast healthcare practice.
But for all the promise Free Trade may show, it's also generating an equal amount of doubt and controversy. Problems aside, Canadians tend to take great pride in their medical system, which guarantees free care for all and bars citizens from paying for medically necessary procedures. For a short time, Hillary Rodham Clinton even gave Canada's system serious consideration as the model for guiding the administration's ill-fated healthcare reform effort in the U.S.
"The people now talking about brokering services are preying on Canadians' fears that they won't be able to get the treatment here," says Michael Rachlis, M.D., a Toronto-based physician who is considered among Canada's foremost healthcare policy experts. In an interview with the Toronto Star newspaper last December, he referred to Free Trade as a "parasite."
Indeed, Hitchlock knows his company is being examined with withering skepticism. During a recent telephone interview, he detoured a couple of times from the questions to defend Free Trade's rationale.
"We're not trying to attack the system," Hitchlock says, adding that sending patients to U.S. facilities with excess capacity would increase resources for Canadian doctors and make them more efficient. "We're trying to move it along faster."
But detractors like Rachlis see the Canadian concept of healthcare being rushed out the door as well.
"One of the hallmarks of the system is that Canadians get everything based on need, as opposed to the U.S. The feeling is no one should be getting preferential treatment," he says.
But even staunch supporters of Canada's system such as Rachlis agree the 40-year-old experiment is under enormous stress. Hospitals have been closing, while doctors are grumbling about pay and sometimes balking at taking on more work. As a result, patients often wait months for diagnoses and surgery. Some provinces have been reluctantly sending expectant mothers to U.S. border hospitals to give birth.
"While Canadians are continually told that our health system is one of the best, this rhetoric masks serious problems stemming largely from the structure of healthcare delivery itself," Rachlis wrote in a recent paper commissioned by the National Forum on Health. "These problems include documented shortcomings in the quality of care and services."
Cynthia Ramsay, a Fraser Institute healthcare economist who co-authored the study on waiting times for physicians, said the creation of a company like Free Trade is "inevitable," given the problems Canadians face in getting care. But she is also doubtful about its long-term viability.
"The problem is we support the Canadian system in theory; we really embrace the concept," she observes.
Ramsay is also uncertain as to whether Canadians have reached the breaking point over delays in seeing a doctor. But she believes Free Trade can help illuminate that problem.
"What we will get out of this is some hard data about Canadians going to the U.S. for treatment," she says.
Hitchlock emphatically agrees with that view.
"This will make the Canadian system work better," he says.