First-rate health care for second-rate citizens?

There’s a disparity in the cost of medical treatment for those in rural communities, and it needs to be addressed.

Last weekend’s Janeway telethon raised almost as much ($2.9 million) as it did last year ($2.97 million). The majority of the funds go to purchasing equipment for the various departments such as the Neonatal Intensive Care Unit, which is where I directed my tribute donation (I’ll tell you more about that next week). Aside from the regular calls for a heritage fund from non-renewable resource revenues to pay for this sort of budgetary shortfall, I think it’s spectacular that around 8,000 donors from all over Labrador and Newfoundland fill the Janeway funding gap. Our children future deserves it.

Now mind you, $3 million isn’t a huge unintentional “gap”. In fact, fundraising tends to be as much about publicity and public support as it is about a paltry three million bucks (in a province that doesn’t mind spending three times that amount on NOT paving roads, say). No, it’s about reminding everyone that we have this facility, we have people with needs in our communities, and they do great work.

People in our communities

I believe—and maybe (definitely) I’m cynical—that when it comes down to it, running an expensive annual telethon, and all the balloon purchases that involves, is more about reminding us that people also need support accessing the Janeway. As in, those of us not in the ‘metro’ St John’s area have children in need of extra care at (theoretically) the same rates as those in rural Labrador and Newfoundland. So when those families in need have to access medically necessary treatment for their children, they have to raise money.

So that’s my craw: all of the major educational, medical, specialist, dental, etc. needs of the province are delivered in St John’s (and other ‘major’ population centres). It makes sense — clearly governments need to deliver programs and services to the most people in the most economical way possible. So yes, the Janeway, Memorial University, health and dental facilities, etc. all need to be based in bigger centres, and the rest of the population need to travel to access those services.


We all pay for those facilities and services. The whole province. And yes, I’ve made my little rant about Labrador’s half billion dollar annual over-investment in provincial program and services funding before. Labradorians also pay the highest amounts to access the facilities and services that our revenues support; one family estimates their cost to access these services is $6,000 to $7,000 (not counting lost wages) — and that’s from Goose Bay, not even the coast. We simply can’t jump in a car and drive there. But that’s just my obligatory reminder; I recognize there’s another quarter million Newfoundlanders that also have to pay to access services that are provided (essentially) free to those in the capitol. Again, nothing against the townies (and Avalonians).

My issue is that income tax pays a tiny fraction of the provincial budget (so sorry St John’s, you’re just not that important to the budget). Oil, minerals, fisheries, and so on drive the corporate (Avalon) taxes as well as the provincial revenues of this province. So when we have limited facilities—that we all paid for through taxes and revenues (and Janeway telethons, say)—we should all have equal access to those facilities.

There are programs…

To prove I’m not always just trying to rip the government, there is an excellent series of subprograms in the Medical Travel Assistance Program. In fact, this PC government actually improved the program to allow 50 per cent of travel to be paid for in advance if a physician and the bureaucracy approves it. So yes, in a way the government helps balance off the differential cost for rural residents versus ‘urban’ ones. My issue really, really comes down to how difficult it is to access that program.

First off

Many people aren’t informed about it or given assistance in applying for it. I’ve heard plenty of stories of people having to rush off only to bear a huge burden of personal cost and missing the pre-clearance rules for the program which allow for reimbursement. Keep in mind the average income in the province is about $20,000 a year. In Coastal Labrador, by contrast, average income is $13,100 to $15,500 a year. So a $6,000 to $7,000 hit per visit, plus salary loss, is astronomical.

Now, some might say, “Well that’s the cost of living out in Buffox Cove — if you want good services move to an urban centre.” I’ve heard this before, but let me remind you: urban areas rely on revenues generated out in rural Newfoundland and Labrador. As a further reminder: Voisey’s Bay provides, on average, $100 million per year to the province.


The whole process of having to apply for and get approval in advance from local clinics, doctors, regional health authorities, and then the bureaucracy in St John’s is just wholly burdensome. I understand there needs to be oversight and approvals and all that (I was a—grudging—bureaucrat for many years in Ottawa). But seriously, if it’s essentially a rubber stamp approval process in St. John’s, why not let regional health authorities do the pre-approvals (and the rubber-stamping)?

When families are needing care for their children—take it from me—you don’t give a rodent’s behind about paperwork and bureaucracy. You just want your child to have the care they need, and you want it yesterday. Due to the refund-based nature of the Travel Assistance program, many communities (especially my industrious hometown of Cartwright) have taken it upon themselves to raise funds to support medical travel in advance in the hope that when refunds are approved by the provincial government it’ll go back to the fund.

One little tweak

What I’d love to see—failing a heritage fund to cover things like this—is to have pre-approval authority by health boards. Health boards, and airlines like Air Labrador and Provincial Air Lines, have the capital to fund travel for people in emergency and other medical travel situations and collect it later in the case of non-approved travel. Individuals don’t. Right now, people get pre-approval from their clinic to go to a hospital, where they get approval from a doctor for additional medical care, which is then approved by the health board, and then they apply for approval from the provincial government (to maybe get reimbursed later).

It’s far easier and more fair for people to get approval from doctors and health boards at a local level for medical travel, and have pre-approval for assistance programs, than it is for individuals to apply and wait for approval from some bureaucrat in St John’s who actually bases their decision on the local health board/doctor in the first place.

Why the extra step?

Ditto for the air ambulance (family member escort) program. Why do we have to wait for some kind of approval in advance for families to travel with loved ones, when essentially the local health board decision is going to reign anyway? We all know that having loved ones around during our healing process is: a) less stressful for the patient, b) helps the healing process significantly, and c) fair for all citizens of the province. Not just those who happen to be born in more densely populated areas.

We’re in it together, or we’re not.

Editor’s note: If you would like to respond to this or any article on, or if you would like to address an issue we haven’t yet covered, we welcome thoughtful and articulate Letters to the Editor. You can email yours to: justin(at)theindependent(dot)ca. Not all letters will be printed, but all will be read.


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