OHIP’s balancing act: What is the price of a...
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May 31, 2014  |  Vote 0    0

OHIP’s balancing act: What is the price of a child’s life?

Hamilton Spectator

How do you put a price on the life of a six-year-old girl?

Up to $800,000 seems like a small cost to Ontario's $49-billion health system for Anya Martinez to get a promising treatment in the United States that is the Ancaster girl's best hope of beating a recurring cancer.

But what if it comes at the cost of timely heart surgery or a new magnetic resonance imaging machine?

"These stories are very difficult because they evoke in all of us this desire to rescue, save and intervene at any cost, especially when it's a young child," said Dr. Ronald Labonté, a professor in the faculty of medicine at the University of Ottawa who holds a Canada research chair in globalization and health equity.

"The problem we face is we have a publicly funded single-payer health system. That means, of necessity, we have to ration certain kinds of services. If every experimental clinical trial/intervention around particularly rare or difficult diseases were funded by the government, we would not be able to afford anything else."

Where to draw the line gets more difficult as the number of requests increases.

"As more and more novel interventions into chronic diseases are put forward on the market and as we have an aging population, there will be more pressure around people wanting to try these unusual interventions," said Labonté who edited a book called Travelling Well: Essays in Medical Tourism.

"It's going to pose a challenge to public health systems in terms of how they try to manage it."

What to fund out-of-country was a question put before OHIP roughly 30,000 times from April 1, 2012, to March 21, 2013, states the latest Canada Health Act annual report. During that time, Ontario paid out $43.8 million for hospital care and $6.5 million for doctor services outside of Canada.

The funding is a dramatic reduction over five years at the same time the number of requests went up, showing the government's increasingly unwillingness to pay for out-of-country care like Anya's. Ontario spent more than triple in 2008/2009 what it does now for hospital care outside of Canada despite having nearly 8,000 fewer claims. It paid $136 million for nearly 22,000 claims that year.

At the same time, the amount going to doctors outside of Canada plummeted. The funding was more than eight times higher at $54.8 million in 2008/2009.

"It's a travesty," says former OHIP lawyer Perry Brodkin, who now represents patients. "It's just shocking when you look at it. How did we go from $136 million to $44 million? They changed the laws over the years to make it virtually impossible for anyone to be paid or reimbursed or to have their appeals granted."

The criteria to be funded out of country leaves little hope for Anya and patients like her whose only option is a clinical trial recommended by their doctors. OHIP will not fund any treatment that is experimental or done for the purposes of research. It has to be generally accepted by the medical profession in Ontario. The treatment can't be available in Canada or must have an unreasonable delay here that could be life-threatening or result in irreversible tissue damage.

The leaves a very narrow window that Anya's request for treatment, being studied at the Children's Hospital of Philadelphia, doesn't meet despite being successful in 24 of 27 patients. The family also appealed to the American hospital to treat her for free on compassionate grounds, but they were refused.

"OHIP and the whole process disgust me," says Anya's dad Michael Martinez. "It makes me sick."

Barry Stein, a Quebec lawyer who won a precedent-setting case in 1998 reimbursing $250,000 in costs for him to go to the United States for colorectal cancer treatment, describes the stress of having to battle the system at the same time you're fighting for your life.

"When you first get the news and you face these challenges, it's paralyzing," he said. "It's horrendous emotionally. It can really break you down. Then you have to pull yourself up and fight and maybe survive."

The Martinez family can take their case to the Health Services Appeal and Review Board, but their chances are slim. The board only granted out-of-country funding in four appeals and partial funding in another case last fiscal year. During the same time, it opened 57 appeals. Also, the appeals can take more than a year, which is time Anya doesn't have.

The dilemma of what to do about compelling but costly cases like Anya's is "a world of competing sorrows," says Margaret Somerville, one of Canada's top medical ethicists.

"Of course, you want to do everything you can to help the child," says Somerville founding director of the Centre for Medicine, Ethics and Law at McGill University. "On the other hand, it's a zero-sum game with your health-care resources. There is also an equality issue that if you do it for one person, you have to do it for everybody in the same situation … You can't favour one person at the expense of everyone else."

For more information or to make a contribution to Anya, visitwww.gofundme.com/littleanya or facebook.com/savinglittleanya

jfrketich@thespec.com

905-526-3349 | @Jfrketich

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(8) Comment

By Diane | JUNE 02, 2014 08:54 PM
What is the cost of keeping this child in a Canadian hospital vs an American hospital without the cost of this treatment? OHIP should at least cover that. I'm tired of hear drugs are to expensive and can't be approved. Why isn't our government going after these drug companies. There's no need for what they charge
By Bob | MAY 31, 2014 09:15 PM
@Michelle cont'd..As well have a look at all the child centric programs Mac has eliminated and reduced. Write a letter and ask where your money went. Don't expect an answer though. They LOVE people like you.
By Bob | MAY 31, 2014 09:13 PM
@Michelle. You seem to think that only those who have no children could possibly disagree with you. That having children puts you into some otherworldly place. CRAP. I have a daughter, a son in law and 2 wonderful grandchildren. If any of them had a life threatening illness I would do everything in my power to help them. I would NOT expect the rest of the world to take a back seat to meet my needs. My tax dollars go every day to meet the needs of those less fortunate than myself. You are very arrogant and delusional if you think that donating to a Child focused hospital gives you some special status.
By Boomer | MAY 31, 2014 07:52 PM
@Michelle: You're letting your emotions get the better of you. In fact, @Bob is exactly correct. This is an early phase clinical trial which means that they still haven't proven the efficacy and safety of the CART intervention (i.e. they don't know if it works yet - and they won't know the answer for another 2 years). The results quoted are really only anecdotal at this stage. If you are angry that this trial is not being run in Canada, then I suggest you should turn your anger towards the current federal government that chooses to provide limited funds for research into diseases like this.
By Michelle | MAY 31, 2014 04:25 PM
@Bob: If you read their article the other day, you would have seen that the family was willing to sell their house. If it was your child, wouldn't you? You obviously have no kids. My son did 2 fundraisers for McMaster hospital a few years ago raising over 11 thousand dollars, not because he or anyone in the family had been sick but because he wanted to. Either donate to the cause or shut up about it.
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