By Fran Yanor / Legislative Reporter

Rural residents who traveled outside their community to access health care paid an average of $2,200 per person, per health issue, in out-of-pocket expenses over the past three years, according to a recent survey from UBC’s Centre for Rural Health Research.

“The big issue, of course, is transport and travel,” said the Centre’s co-director and UBC associate professor Dr. Jude Kornelsen in an interview earlier this year when discussing rural health care concerns.

Whereas people living in urban centres can reasonably access non-urgent care such as specialists’ consultations and diagnostic testing, those living in rural areas often need to travel long distances to receive similar care, according to the Out-of-Pocket Costs for Rural ResidentsWhen Traveling for Health Care report.

“Travel for non-urgent care falls outside the responsibility of the health care system,” reads the report, “leading to downloaded costs to patients and their families.”

Survey respondents were asked to report on out-of-pocket spending for one health issue that required travel outside their community at least once between 2017 and 2020. Seventy-five per cent of participants said they’d traveled between one and six times. Expenses identified were transportation, food, accommodations, lost wages, childcare, and costs for a travel companion.

People traveling from the most remote areas and those requiring treatments for chronic conditions are hardest hit by out-of-pocket expenses, according to recent survey findings by the Centre for Rural Health Research. Chart and data courtesy of CRHR.

“It’s an inconvenience, but it’s also very difficult for people to access care outside of their own community,” said Ed Staples, president of the BC Rural Health Network, a cross section of rural community organizations advocating for health care policy improvements.” 

On average, between 2017 and 2020, patients paid $777 in transportation costs and $674 for accommodations per person, per health issue.

Nearly 80 per cent said they had difficulty paying for costs with 21 per cent saying they’d borrowed money to pay expenses. Only 14 per cent of survey recipients said they got financial help from an organization. Fifty-nine per cent felt traveling for health care affected their health negatively.

“What we didn’t know was the severity of it,” said Staples. “What we didn’t have was the evidence, the facts, the data, to support what we already knew, and that’s what this survey does.”

According to the survey report, a next goal is for health care stakeholders to engage rural citizen patients in ‘deliberative dialogue’ to determine how best to support patient travel to access health care.

The survey included patients from across the province (26 per cent from the north) with the highest costs incurred by patients living in remote locations and those requiring treatment for chronic conditions.

Over the years, Bryan Hannis and his wife have incurred tens of thousands of dollars traveling for out-of-community health care.

“All of my tests and my wife’s tests are out of town and some of them are multiple appointments per year,” said Hannis from his Valemount home. Like many survey participants, most of their trips relate to specialist consultations or diagnostic testing.

Eighty per cent of people surveyed had a co-traveler who incurred out-of-pocket expenses, particularly for transport and accommodations.

Hannis usually claims back their expenses through Revenue Canada which doesn’t allow for the costs of a companion, he said, but the bulk of the couple’s mileage, food and accommodations are usually covered for non-urgent health trips.

Unlike some people who have to fly to get care, Hannis and his wife usually drive, to Kamloops, Hinton or Edmonton. “To see a specialist, you have to get a letter from your local clinic stating that there are these tests are not available in your area,” said Hannis. “So you drive to the closest facility that has that test.”

Many people said transportation was the most stressful part of accessing health care outside their community, particularly for people living in challenging geographic locations.

Airline tickets were the most pricey transportation expense, while gas was the most common, according to the Out-of-Pocket Costs for Rural Residents When Traveling for Health Care” report. Chart and data courtesy of the Centre for Rural Health Research.

“We recognize that there’s no specialist or sub specialists in rural communities so people are going to have to travel,” said Kornelsen. “But shouldn’t travel be the last option?”

If specialists visited the communities or telemedicine was more widely used, residents could avoid unnecessary travel by connecting with physicians, nurse practitioners or specialists virtually.

“Then if all else fails,” said Kornelsen, “you move to transporting people.”

Regardless of advances in telemedicine, some health concerns may always require face-to-face care.

A fact well known to Hannis and his wife. Around 40 years ago, when their son was a pre-transplant dialysis patient, they drove the 400 or so kilometres back and forth to Edmonton 80 times or more over a five year-span, he said.

“We’re in the middle of nowhere and we’re doing dialysis,” Hannis recalled.

At the time, they had to cover all the expenses themselves. After several years, they received a back payment of $7,500 from Revenue Canada. It didn’t cover all their costs, but it was something.

In this regard, from a health perspective, the Hannis family are a rural success story.

After a kidney transplant, their trips to Edmonton lessened to three or four times a year, and their son is now doing very well, said Hannis.

“I gave him a kidney in ’82 and it lasted until two years ago,” he said.

Their son is currently operating on transplant number two, a ‘perfect match’ from his brother, said Hannis. No one knows how far that will take him, but Hannis is betting long. “I think it’ll last him until he’s grey-haired anyway.”

Fran Yanor / Local Journalism Initiative / The Rocky Mountain Goat / [email protected]