As a nation, we are constantly seeking out new free trade agreements. That is because we recognize the fundamental principle upon which free trade is based — that each country should produce products in which it has a demonstrated comparative advantage.
In our hospital operating rooms, we accept that it makes sense to employ state-of-the art diagnostic instruments assembled in the U.S. or Mexico from south Asian components. Our medical instruments are crafted from the finest German steel. Other components of the theatre are manufactured to the highest standards, sourced around the world.
To meet increasing demand and a shortage of qualified practitioners, we even staff our rooms from overseas — encouraging immigration of doctors, technicians and other support staff from countries whose standards of medical education have dramatically improved.
It is becoming increasingly clear that when it comes to many specialized medical procedures, comparative advantage is shifting to select sites in countries like India, Thailand and Indonesia. Will the day come when we will recognize that, just as it makes sense to import the hard components of the operating room, it may make as much sense to have the procedures themselves outsourced abroad?
An aortic valve replacement might cost the Canadian health system $100,000. The same procedure carried out in one of the dedicated clinics in the erstwhile Third World might cost as little as one-tenth of that — plus a couple of return airline tickets. They will even throw in a few days of sun-drenched R&R to speed recuperation.
The principles of free trade apply to services just as they do to manufactured goods.
While health care available to most Asians falls short of First World expectations, hospitals dedicated to serving the well-heeled and the international value seeker have been established to world standards. Surgeons and physicians have been educated in the United States or Western Europe. Administrators are typically U.S.-trained. Local nursing and support staff provide a degree of personal attention long vanished from Canadian institutions. Surgical facilities are state-of-the-art, and accommodation and recuperation amenities are downright luxurious. As with so many imports from the region, costs are a fraction of what they are in Canada.
Bangkok’s Bumrungrad International Hospital handles well over a million patients annually — almost half a million of them from outside Thailand. There is a staff of 3,500, 19 operating rooms and a complete range of diagnostic equipment. Outpatient services are housed in a new 22-storey building. Every step of a patient’s admission, treatment and recuperation is tracked through a single-platform information system that is even linked to a robotic pharmacy dispenser. No wonder some 30,000 North Americans travel to the hospital each year.
So, will the day come when Canada’s public health system will routinely ship patients out of country for treatment? That day is already here. The Ontario Health Insurance Plan regularly pays for many treatments in the United States — when services are not locally available or when wait times become excessive.
If to upstate New York, why not to Thailand? The main difference is that while treatment in Asia could save our system hundreds of millions of dollars and reduce or eliminate waiting times, it would also introduce massive price competition into medical services. If you think the Canadian health establishment will flock to endorse that suggestion — you may need a frontal lobotomy! Which, by the way, is available at a fraction of what it would cost in Canada!
Don McIver is a Senior Fellow at the Atlantic Institute for Market Studies, an independent economic and social policy think tank based in Atlantic Canada.