Some patients pay thousands while others nothing at all in 'medical postal code lottery'

Two men, different provinces, the same life-changing surgery, yet one has to pay out of pocket and the other is covered by the public health-care system in what some call Canada’s medical “postal code lottery.”

Peter Pawlik, a hearing-impaired Calgary man, is travelling to Austria to get a life-changing medical device surgically implanted that will help him hear clearly for the first time. Because the Alberta government won’t pay for the surgery, his retired parents are footing the $ 50,000 bill.

It’s a trip they wouldn’t have to take and a cost they wouldn’t have to bear if their son lived in another province.

Peter Pawlik (right) and father George Pawlik

Peter Pawlik, right and father George pause to take a selfie on their journey to Austria, where Peter will undergo surgery to receive a Bonebridge hearing system. (Peter Pawlik)

“I’m old and I don’t know how long I’m gonna live. I can’t leave him knowing there is something somewhere which can help him,” father George Pawlik told Go Public in an interview from his home before he left the country with his son.

The Pawlik family tried for years to get surgery in Alberta for a Health Canada-approved bone conduction implant doctors say could restore Peter’s hearing to “almost normal.”

The 35-year-old was born without ear canals and underdeveloped ears: conditions called bilateral atresia and microtia.

George Pawlik

George Pawlik packs for the trip to Austria, where his son will receive a surgery to improve his hearing. (Michael McArthur/CBC)

He has been diagnosed with several mental health issues, which his psychiatrist links to his inability to hear clearly.

His father says Peter is depressed and feels isolated, and that he can’t work, shies away from social contact, and didn’t want to be interviewed.

George Pawlik says navigating the Canadian health-care system has been frustrating, and that the family faced delays and received conflicting information even when they offered to pay for the surgery themselves.

Eventually, they gave up and booked the surgery overseas. “If something is possible to do, we have to do it,” Pawlik said.

Alberta Health tells Go Public the last time it looked at insuring this type of implant was in 2013 when it decided there was “a lack of evidence that these implants were safe and effective.”

Half of the provinces in Canada did their own reviews and decided the implants should be publicly funded.

Canadians have to live in a province for more than three months before they are covered by medicare there.

Different province, different system

Ross Weiss lives in Saskatchewan. He has the same condition as Peter Pawlik in his left ear and in 2015 he had the same surgery. The province of Saskatchewan paid for it.

Ross Weiss

Ross Weiss of Saskatoon had Bonebridge implant surgery in 2015 and says the improvement to his hearing has been ‘a life changer.’ The external audio processor is worn above the ear, magnetically attached to the bone conduction implant which was surgically embedded in his skull. (CBC/Chanss Lagaden)

“It’s not fair. Everybody should have access to something of this nature because it is a life-changer,” Weiss told Go Public.

 “I’m very happy to live in a province that does cover the surgery.”

Physicians frustrated

Dr. Vincent Lin, an Ontario head and neck surgeon, says Alberta should revisit its decision not to fund the surgery. Ontario pays for the surgery, and Lin has done more than 80 operations to implant Bonebridge hearing devices in the last few years.

Dr. Vincent Lin

Dr. Vincent Lin, a head and neck surgeon at Sunnybrook Hospital in Toronto, holds the part of the Bonebridge hearing system that is surgically implanted in patients’ skulls. He has performed the surgery about 80 times. (CBC/Ivan Arsovski)

“There’s been numerous studies … where it’s been freely available for years now, where it shows that Bonebridge has a huge advantage for patients with this type of hearing loss,” Lin said from his Toronto clinic.

He says patients who would benefit from the implant have to go without if they can’t afford the surgery in provinces where it’s not covered and that is an “ongoing frustration with physicians, in many many fields.”

Medical ‘postal code lottery’

Health-care advocate Adrienne Silnicki says she hears stories like Peter Pawlik’s all the time.

Adrienne Silnicki

Adrienne Silnicki, national director for policy and advocacy at the Canadian Health Coalition, says hearing devices are just one of many areas of Canada’s health-care system where covered services and devices vary widely among the provinces. (David Richard/CBC)

“It’s not just for hearing devices. It’s for pharmaceutical and dental care and vision, all of these pieces of the body that we left out of the Canada Health Act,” said Silnicki, who is the national director for policy and advocacy at the Canadian Health Coalition.

Medical devices and medicines are approved by Health Canada, but it’s up to the provinces to decide what they will or won’t cover.

“The postal code lottery is a perfect way of describing it. We have this patchwork of systems where people are trying to access services, but they may not be able to access it in their province.”

Silnicki points out the “great divide” between “have and have-not provinces.” The ones that have more money to spend on health care sometimes offer more procedures, but she says it’s not just about funding but about using money they have more wisely.

Peter Pawlik

Peter Pawlik’s current hearing system, which he’s used since childhood, requires him to wear a headband and it only gives him limited hearing. (George Pawlik)

A new Canadian Institute for Health Information study found 30 per cent of medical care in Canada is unnecessary and wastes health-system resources that could be put to better use.

Silnicki would like to see the federal government work with the provinces and territories to ensure all Canadians have the same access.

Peter Pawlik’s surgery is scheduled for Jan. 8. His retired parents will have a big bill to deal with, but his father says it will be worth it if his son’s hearing improves.

“Peter was talking all the year about this, and this is first time that he has some sparks in his eyes, that he was believing that something would change in his life,” his dad said.

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