Courage Lives Here

Dear Colleagues,

In an editorial in this morning’s Toronto Star, Premier Wynne and Minister Deb Matthews are encouraged to put an end to UHN’s International Program. Indeed the Star suggests that these activities put our publicly funded, single tier health system at risk. I want to assure you that UHN’s program, far from threatening our single payer system, is actually an important element of how our system needs to innovate to continue to provide hard working Ontarian families with access to the world’s best healthcare. The Star has missed the point in its editorial and I want to tell you why they are wrong.

International patient care at UHN is not new- we have been doing this for many years and it is an important aspect of our UHN culture. One of our first international patients was Elizabeth Hughes, daughter of the Governor of New York, who came to the Toronto General in August 1922 to receive the new miracle drug insulin in treatment of her diabetes.  Thirty years ago we were very proud that Dr. Joel Cooper performed the world’s first successful lung transplant at Toronto General. Several of the first lung transplants were actually performed for American patients since Canadian doctors were unwilling to refer patients because transplant was considered to be too risky. And we recently celebrated the 50th anniversary of the discovery of blood forming stem cells at Princess Margaret’s Ontario Cancer Institute. This discovery allowed us to become one of the early international providers of life saving bone marrow transplant. For many years we have provided transplants for international patients whose governments pay for them to receive treatment at our internationally recognized Princess Margaret. The funding received for treating these international bone marrow transplant patients allows us to hire more nurses and open more beds for treating Ontario patients.

Today we are providing care to small numbers of international patients who choose to come to UHN for treatment that is not available elsewhere or is not available in their home country. In most cases the care that these patients receive is paid for by their government. For example, the Canadian government asked UHN to help out treating Libyan patients who had been severely injured in that country’s recent civil war. For about two years now we have been treating Libyans in our Altum Health facilities at Toronto Western Hospital. The funds that we receive from treating these international patients are used to shorten waiting lists for Ontarians. We never cancel treatment or surgery for an Ontarian patient in order to treat an international patient. The extra funding that we receive for treating international patients is used to open extra operating rooms that can be used to treat Ontarians. We carefully account for all the revenues received from international patient care and report quarterly to our board on these funds. In general we are able to treat two extra Ontarian patients off the waiting list every time we treat an international patient. Our international program shortens wait times for Ontarians by allowing us to open more operating rooms and beds.

Our International Patient Program is only a small part of UHN’s international activities however- after all- our hospital vision is “To Achieve Global Impact”. UHN clinicians and researchers have many international collaborations and activities and some of these activities generate important revenues to support our programs here at home. For example, our terrific UHN Kuwait team provides important consulting services to the Kuwait Cancer Control Center. The profits from these consulting services are being invested in a variety of important resources for our Cancer Program including funding space for clinical trials and investing in our electronic patient record of the future. Both of these activities are essential to delivering Personalized Cancer Medicine to Ontarians in the future. We need a variety of sources of funding- from our foundations as well as international revenues- in order to develop future cancer treatment strategies that are cutting edge and currently appropriately not funded by our Ministry of Health.

If UHN is going to continue to innovate across all of our programs and develop the treatments of the future for Ontarians we need a variety of sources of innovation funding that are not available from taxpayers. This includes our international program which generates most revenues through consulting on how we provide care at UHN. In order to develop revenues from international consulting work we will occasionally need to treat international patients who cannot get treatment in their home country. This is a very small amount of activity- remember that we provide over a million visits to Ontarians every year- and generally treat about 100 international patients annually- less than 0.1% of all our clinical activity. Our Board carefully reviews the financial results from this international work- and the Board is extremely vigilant that no Ontario taxpayer money is spent on this activity- and those revenues from treating international patients shorten wait times for Ontario patients.

As you all know, I am a very strong supporter of our single payer publically funded system where every Ontarian is treated according to their needs rather than their ability to pay. However, if our Ontario system is going to remain at the forefront of international care- rather than slipping into mediocrity- we must innovate in how we raise funds for developing new treatments like the insulins of our future. Our international program is a great example of innovation in achieving new sources of revenue. However our international program is not only about generating revenues. Being involved in international consulting and international care is an important element of our global impact- and allows us to speak proudly and teach other people about our Canadian healthcare system. It also makes us better healthcare providers by learning about other health systems and cultures- and makes us better at serving our diverse community in Toronto.

Innovative organizations open themselves to criticism by doing new things. It is very ironic that UHN- an organization whose culture exemplifies the best aspects of our public Canadian system- would be accused of putting our Canadian system at risk by the Toronto Star. It would easy for us to avoid controversy, avoid innovation and simply keep on doing the same things without inventing the new treatments, methods and ideas that are supported by international engagement. That would be a simple quiet path to mediocrity- but our Canadian system deserves better- and it requires courageous organizations that are not be afraid of change nor the criticism that innovation can bring. Our Canadian health system needs courage to innovate and change- and UHN is proud to be a leader of that innovation- because courage lives here.

Bob