As of Wednesday morning (Dec. 9), non-Canadians who are legally able to work in Whistler are being offered partial refunds for X-rays and other services at the Whistler Health Care Centre if they paid the recently implemented "cost recovery" fees for out-of-country visitors - rates that one local physician said are "exorbitant."
For example, an Australian who is living and working in Whistler and produces an invoice with the higher, out-of-country fees and a copy of his or her work visa at the center will have the bill adjusted to much lower rates designed for B.C. residents who are not signed up on the province's medical services plan (MSP), said Anna Marie D'Angelo, a spokesperson for Vancouver Coastal Health (VCH), which runs the centre.
The difference in cost can be hundreds of dollars for a single X-ray, with the price list for B.C. residents without MSP coverage listing wrist and shoulder X-rays at $68.10 apiece. VCH's "cost recovery" fees for out-of-country visitors, which were implemented in Whistler in August, are $230.40 for the wrist and $316.80 for the shoulder.
The difference in price for a lumbar spine X-ray is $102 vs. almost $550.
Patients who should have received the lower, resident rates have been getting charged the higher out-of-country rates at the Whistler centre, D'Angelo said Wednesday (Dec. 9).
"This is a new system and we do apologize. We probably should have communicated this better," she said.
The VCH move to offer partial refunds came after Dr. Cathryn Zeglinski of the local Northlands Medical Clinic went public earlier this week with her opposition to the new out-of-country X-ray costs. She has been trying to find out for the past several months why X-ray charges jumped by more than 500 per cent in some cases - and she's concerned because some patients are opting not to get the scans because they can't afford to pay the new rates.
She said she's seen a non-Canadian patient pay more than $1,000 for four chest X-rays in Whistler that would have cost in the neighbourhood of $300 if they'd been done at a private clinic in Vancouver. Another patient chose only to have his wrist X-rayed even though it turned out his hand was also broken because he couldn't afford both scans, she said.
"These are exorbitant and there's no way around it," Zeglinski said Monday (Dec. 7). "It's insane when an X-ray costs almost as much as an MRI."
Comparing the 2007 VCH rates for out-of-country patients in Whistler with the new fee schedule that arrived by fax at Zeglinski's office without warning in August, the cost for a wrist X-ray jumped from $95.25 to $230.40. A shoulder X-ray went from $95.25 to $316.80, and a lumbar spine X-ray from $95.25 to a whopping $547.20.
That's an increase of more than 500 per cent.
"How can you justify this kind of increase? Where are they getting these numbers?" Zeglinski said.
D'Angelo said the charges for non-Canadian patients were reviewed and adjusted to make it less appealing for visitors to remain in B.C. to receive cheaper care than in their home country. Most out-of-country visitors to B.C. are from the U.S., so VCH officials looked at comparable fees for such procedures in the U.S. and set equivalent rates, she said. The Ministry of Health helped set the new rates, she added.
"All we're doing is cost recovery. We're not making a profit," D'Angelo said. "We feel that it's very reasonable."
Any money generated goes right back into patient care, she added.
D'Angelo said it's "disturbing" to hear that some patients are opting not to get proper medical attention in Whistler because of the fees. VCH policy is to treat people first and then work with them to recover the costs, she said. Some people are on payment plans.
"No patient is ever denied treatment due to their inability to pay," she said.
But Zeglinski said the claim that nobody is turned away is "B.S." Patients at the Whistler Health Care Centre are told the costs up front and are asked if they're paying by cash or credit card. If they don't pay they don't get treatment, Zeglinski said.
For out-of-country patients who also choose to see a doctor at the Whistler Health Care Centre for initial assessment - rather than using a clinic such as Zeglinski's - the X-ray increases are charged on top of a $500-per-visit administration fee that VCH implemented in late 2007.
International visitors are also paying more to access Whistler's new CT scanner than they would at a private clinic in Vancouver, Zeglinski said.
That's "very disappointing" to local resident Marnie Simon, who worked for years to help raise money so Whistler could get a CT scanner. From the figures she's seen, the fees are "outrageously expensive" for private patients, Simon said.
"I'm very disappointed the fees are as high as they are," she said. "I don't think it's quite right to do that."
Though D'Angelo said she couldn't comment on what prices might be at private clinics in Vancouver, the costs are likely lower because they don't include a "facility fee." When you go to a VCH facility like the Whistler Health Care Centre it's more than just an X-ray clinic, so a facility fee is part of the X-ray cost, she said.
"We're prepared for every eventuality. We're stocked for everything," she said.
But Simon said that argument doesn't hold water in the case of Whistler's CT scanner. The cost of the facility and the scanner itself were donated, so VCH is only paying to operate the scanner, she said. Even maintenance costs are covered by donations for the first three years.
"Recouping the cost of the facility isn't really an argument you can make because they didn't pay for it," she said.
Zeglinski also argued that patients who only access Whistler Health Care Centre for an X-ray shouldn't have to pay a "facility fee" because they're not using the whole facility. It's no different than accessing the service at a private facility, she said.
Zeglinski said the fees aren't good for medical care or tourism. She doesn't want Whistler to have a reputation for gouging people if they get injured here.
"When they feel they're gouged it's one more thing that will cause people not to return," Zeglinski said.
However, she said if a patient hits his/her head in a fall on the mountain and decides not to get an X-ray because he can't afford it, "they could end up being quadriplegic."
D'Angelo urged all visitors to Canada to have travel insurance. Zeglinski strongly encouraged all seasonal residents to register for B.C. Medical Services Plan coverage.