Friday August 29, 2014

Ambulance services not free, or cheap


A letter to the editor this week was one of those moments as a journalist that gives pause. The writer Dave Carr, from Ituna, was obviously in a grave state of grief and frustration.

“My wife [Catherine] died of cancer,” he wrote. “During her illness she had to be moved between three hospitals, resulting in ambulance costs over $5,000. “I feel I have paid the ultimate price in the loss of my wife.

“We lived on basic government pensions. With her death I am surviving on little more than half that money since we always shared the larger bills. In areas such as Ituna and all the small villages and towns in this health region I know I am not the only one in my position, on basic pensions, being forced to send loved ones from hospital to hospital to save their lives or face losing them.”

Rarely does an email manage to convey this kind of emotion, but it jumped off the screen at me.

Is it a news story, though? It certainly raises questions, such as, is this some kind of negligence on the part of the health region, or maybe an insensitive error?

That is not the case. Ambulance rates are clearly published by Sunrise Health Region. The basic rate is $245 with mileage charged at $2.30 per kilometre (round trip) and a wait charge of $80 per hour. That’s approximately $1,165 from Yorkton to Regina and $1,767 to Saskatoon.

There is a flat rate for seniors of $275, but Catherine didn’t qualify; she was only 62.

Few people probably know any of this and we certainly wouldn’t want paramedics standing there on the doorstep and quoting fees when our loved one is in need, but the fact remains, ambulance service is not free and it is not cheap.

Mr. Carr got a bill from Sunrise to the tune of 5,046. The region did ultimately and compassionately reduce it to $3,562, but that’s still $3,562 Mr. Carr does not have.

I received this statement from the Ministry of Health with respect to this case.

“The Ministry of Health empathizes with the gentleman during his difficult time and we’re pleased that the health region did significantly reduce his bill.

“While ambulance services are not an insured benefit under The Canada Health Act, the provincial health system does subsidize a significant portion of the cost of service.

“In 2012-13, the cost of providing ground ambulance service in Saskatchewan was $115 [million], an increase of $5M over 2011-12. Health regions spent $70 million on the provision of ground EMS services. Other costs are borne by third parties like private insurance, federal and provincial programs, SGI and Worker’s Compensation. Of the $115 million dollars (both grants and billings) spent by by road ambulance services in providing patient care/transport, patients paid 13 per cent of the total cost.

“In addition to funding provided to health regions, the Province also has programs in place that cover, or mitigate, the cost of service to patients. Coverage for emergency ambulance trips for eligible patients with low incomes are covered through the Family Health Benefits program and the Supplementary Health Benefits program.

“However, we recognize that for some patients--especially those living in rural areas--ambulance fees can become significant when kilometre charges are factored in. It’s recommended that residents carry extra insurance.”

Ultimately, Yorkton This Week decided this story was not destined for the news pages. The story screams for op-ed coverage, though. Hence, this column. The Province does a lot, but surely there is a gap here.

How is it that people such as Dave and Catherine, the very people who can’t afford the recommended extra insurance, fall through the cracks and fail to be eligible for supplementary benefits?

To my mind, part of it is the huge demographic rural-urban shift that has been going on for decades causing centralization of health services in major centres. Part of it is the vast increase in medical knowledge and available treatment options for patients who years ago simply would have been declared terminal. With these factors and an aging population, health resources are being strained to the limit of being unsustainable.

We have a lot of work to do to, some of which is being done in an attempt to gain efficiencies, such as the Lean program and other initiatives. A significant effort is being made by community organizations such as the Health Foundation to offset some costs.

Do not be fooled, though, Canada may not have an official two-tier medical system, but in practice, accessibility to services remains weighted in favour of those with financial means as it always has and perhaps always will.

Nevertheless, I am optimistic that smart and well-intentioned people will figure out how to increase the fairness in the system, but it will take time. A lot of time and is cold comfort to those who find themselves in a position such as Dave Carr has.

“Why is it that you choose to punish the poor with out of range costs for small communities?” he wrote. “Yes, I am screaming for justice for myself, but you can bet the family farm that I am and will scream loud and clear about this injustice to people who simply cannot afford this.”



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