It was a Wednesday in early summer 2017 when Tricia Ryan’s life changed forever.
The day before, the Toronto woman, who works as the director of food and beverage research at the Food Innovation & Research Studio at George Brown College, had visited her family doctor complaining of abdominal discomfort.
Ryan’s doctor sent her for an ultrasound, which revealed a mass in her abdomen; the diagnosis was unnerving, but doctors would require an MRI to learn more. That’s when Ryan, 63, first encountered what the Fraser Institute, a BC think tank, describes as a “defining characteristic” of the Canadian healthcare system: Waiting.
According to statistics from Health Quality Ontario (July 2018), the provincial lead on the quality of healthcare, only 37 percent of adult patients received an MRI within the target time, although times varied by condition.
For example, 84 percent of Priority 2 patients (defined as any condition in which failure to diagnose/treat would result in significant deterioration or deficit) were scanned within the target time of two days. However, just 28 percent of Priority 4 patients (defined as any condition in which failure to diagnose/treat would result in minimal deterioration or deficit) were scanned within the target time of 28 days, with an average wait of 56 days.
For Ryan, the numbers didn’t add up. Three days after her ultrasound, she and her husband, Peter, drove to Buffalo, NY, where she forked over several hundred dollars for an MRI. She had just become one of the tens of thousands of Canadians who leave the country each year for medical treatment.
“Uber-ization” of healthcare
Many people like Ryan are Baby Boomers who choose to “reroute” their healthcare – forging new paths that bypass regular practices. Their decisions stem not from dissatisfaction with the standard of Canadian healthcare (indeed, Ryan praises the quality of her healthcare practitioners) but an expectation of superior care and service that has already seen them upend a number of consumer-driven categories, from automotive to retail.
Their attitude is perhaps best summed up by the rise of the term “patient as customer.” Indeed, Boomers are forcing the healthcare industry to meet them on their own terms through a combination of sheer numbers (Canada boasts more than 9.6 million Boomers), force of will and spending power.
Dr. James Aw, chief medical officer for Medcan, a private clinic in Toronto that focuses on a corporate wellness and executive health, describes this as the “Uber-ization” of medicine, with patients increasingly prioritizing ease and convenience while also having a greater say in their treatment.
“They’re more interested in their own health and being an active participant in it, as opposed to a follower,” says Dr. Aw. “Prevention seems to be hot again, as people seem to want to know more about their bodies.”
Meanwhile, a variety of specialist services continue to evolve in order to meet increased patient demand for specific healthcare needs – think the Shouldice Hernia Hospital or clinics that focus on treating varicose veins, as well as some hospitals and other non-profit facilities that are designed around streamlining treatment processes.
In a recent report, NEJM Catalyst said that the growth of specialist practices reflects the healthcare industry’s need to reorganize itself around specific patient (customer) needs, just as businesses did in the mid-20th century. The report said that service delivery is currently organized around what clinicians do and where they do it, with results defined not by how overall patient needs are met, but which discrete services are delivered.
“Reorganizing around the needs of groups of patients with particular needs, in the same way businesses reorganized around particular customers’ needs, is the future of healthcare,” said the report, which describes the current model as “unsustainable.”
The healthcare industry’s long-standing adherence to legacy practices has made it ripe for disruption, agrees Curtis Khan, CEO of the app-based caregiver solution BookJane. Khan spent several years in marketing and technology-related roles with companies including HBC and HSBC before founding his company in 2016.
BookJane now operates in several Canadian markets, including Toronto, Ottawa, Kitchener-Waterloo, Calgary and Vancouver, and recently expanded into the US.
BookJane has two customer bases: individuals and businesses (retirement homes, hospitals and childcare centres). Business clients account for approximately 80 percent of the total hours booked through the platform, says Khan, while overall bookings have grown to approximately 35,000 hours per month (a 200 percent year-over-year increase).
Like many modern tools, BookJane arose in response to a simple consumer need: In this case, Khan’s struggle to find a caregiver for his mother-in-law. “The hospital told us to grab a brochure. There were 100 of them along the wall, and I asked, ‘How am I going to choose?’” says Khan. “It took about eight weeks to find a caregiver, and I said, ‘Can we just simplify our customers’ lives?’”
The app-based product (with a website for corporate clients) now boasts more than 5,000 caregivers.
Like Dr. Aw, Khan uses Uber to illustrate the transformational impact of BookJane, describing the two-year-old service – which enables users to find, message, book and pay for caregivers within the app – as being “like Uber for healthcare.”
He says that Boomers, particularly those belonging to the “sandwich generation” – who are caring both for kids and for their parents – are increasingly relying on services that offer ease of use and convenience, such as Grocery Gateway, Airbnb and Uber.
Healthcare consumers explore options outside Canada
For Ryan, the MRI was the beginning of a seven-month ordeal that culminated with surgery to remove part of her bowel and bladder, as well as her ovaries and fallopian tubes, followed by chemotherapy.
The process led her to reassess her feelings about the Canadian healthcare system with the pragmatic outlook that Boomers are known for. “I believe in universal healthcare, but I also believe that if somebody wants to pay for services if they need them, that should be an opportunity – particularly if they have to hurry the medical profession along,” she says.
Ryan is one of a growing number of Canadians travelling outside the country for healthcare. According to the Fraser Institute, more than 63,000 Canadians – more than 40,000 of them from Ontario and BC alone – left the country for medical care in 2016, a nearly 40 percent increase over the previous year.
In the vast majority of cases, it’s not because the standard of care is better; it’s because people think it’s faster. Long wait times were identified as the primary reason Canadians seek out healthcare in other countries. According to the Fraser Institute’s annual report, Waiting Your Turn, Canadians wait an average of 21.2 weeks between referral from a family doctor and treatment – up from 20 weeks in 2016, and 128 percent longer than the average wait time of 9.3 weeks in 1993.
“[D]espite provincial strategies to reduce wait times and high levels of health expenditure, it is clear that patients in Canada continue to wait too long to receive medically necessary treatment,” stated the report, which also noted that Canadians waited for 1.04 million procedures last year.
Pay what you can
Lengthy wait times have given rise to a wave of services catering to customers who are willing to pay for the privilege of faster treatment or direct access to specialists, such as private clinics, case management companies, healthcare navigators and not-for-profit clinics promising rapid access to innovative, personalized clinical care.
Such expertise isn’t cheap: A 2017 report from The Toronto Star and the Ryerson School of Journalism says that some private clinics charge upwards of $4,500 in annual fees for services that include same- or next-day bookings for serious healthcare concerns, diagnostic tests and wellness examinations.
That article contended that these clinics represent a “second tier” of health services available to wealthier Canadians.
Research shows Boomers are willing to invest in their health and (for those with means) if that involves paying a little extra here and there, so be it.
Ryan is convinced she’d be dead if she hadn’t pursued alternative treatment.
“If you feel time is of the essence, having the wherewithal to look at some of the alternative healthcare options is probably recommended if it’s available to you within reason from a cost standpoint.”
For Ryan, the conclusion is as simple as it is obvious: A changed life is better than no life at all.