B.C.’s cross-border cancer care initiative—necessary, bold and hypocritical

By Bacchus Barua & Mackenzie Moir of The Fraser Institute.

"British Columbia has a new strategy to reduce wait times for cancer care—simply ship patients south of the border.

No joke; over the next two years, the Eby government will use Canadian taxpayer dollars to pay clinics in Washington to provide 24,000 sessions of radiation treatment (plus travel and accommodation) for an estimated 4,800 British Columbians. While undoubtedly good news for some cancer patients facing long wait times for treatment the province, it raises an important question for patients waiting for other types of treatment. Why doesn’t the government expand contracts for private clinics to deliver care within our own borders?

B.C. is clearly failing to deliver timely care to patients waiting for radiation therapy. Last year, the Canadian Institute of Health Information reported that only 85 per cent of patients received radiation therapy within four weeks, the pan-Canadian benchmark established in 2005. In fact, B.C. performs worse on this measure than every province (except for Nova Scotia). And this wait doesn’t even account for the time spent waiting for a consultation with a cancer care specialist in the first place.

However, the same data source (which B.C. Health Minister Adrian Dix is well aware of) also indicates that B.C. fails to meet the pan-Canadian benchmarks for all five priority procedures where data is available (such as hip and knee replacements and cataract surgeries, all with longer benchmarks).

In reality, it’s not just cancer patients being failed by the government’s health-care system. Last year, according to a report published by the Fraser Institute, the median wait between specialist visit to treatment in B.C. across 12 medically necessary specialties (13.4 weeks) exceeded what physicians consider clinically reasonable (9.1) by more than a month. And again, this doesn’t include the 12.4 weeks patients had to wait for a specialist consultation in the first place. Together, the total wait between referral to treatment was 25.8 weeks in 2022—148 per cent longer than in 1993 (10.4 weeks).

And these waits are not benign. Excessive waits of this magnitude can lead to worsening health, the potential for disability and even death. In 2021/22, SecondStreet.org estimated that 2,395 Canadian patients died while on surgical waiting lists.

So while Minister Dix should be commended for acknowledging the reality of unreasonably long waits for some cancer patients in B.C., the current initiative ignores the significant (and much longer) waits faced by patients in need of other medically necessary care including neurosurgery, non-urgent cardiovascular surgery and orthopedic surgery.

Finally, Minister Dix’s actions highlight the hypocrisy of the B.C. government’s attitude towards private care within provincial borders. Just last week, he applauded the effective end of Dr. Brian Day’s legal efforts to provide private care (typically arthroscopic surgery) for B.C. patients failed by the public system. And early in his tenure, Minister Dix made no bones about his intention to “crack down” on private clinics and doctors for accepting private payment for treatments covered by Medicare (extra-billing).

And yet, here the government is, taking Canadian taxpayer dollars to purchase care from PeaceHealth St. Joseph Cancer Center and the North Cascade Cancer Center in Washington State, who will certainly not be subject to the same limitations imposed by Minister Dix on private clinics in B.C.

To be clear, cross-border initiatives like this are nothing new. European Union countries commonly fund certain types of care across international borders within their universal health-care systems, and Canadian provinces have for many years taken advantage of U.S. medical facilities as a safety valve for patients in need of urgent care, and private-care providers in other provinces.

However, B.C.’s selective approach does little to help those suffering long delays for treatment of other medical conditions—many of whom will continue to endure long waits in B.C. or travel abroad on their own dime.

If anything, the Eby government’s cross-border cancer care initiative is a stunning indictment of the province’s health-care system, further highlighting the hypocrisy of provincial restrictions of private care right here at home."