The high costs of a healthcare crisis in rural BC | TBEN news

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Health care in Chetwynd, about 700 miles northeast of Vancouver, is so volatile that Ashley MacWilliam fears it will put people like her asthmatic daughter Aurora at risk.

The hospital in the community of about 2,500 had at least 13 short-term closures last year.

“Even a few weeks ago she had an asthma attack and we had to call ahead to make sure the hospital was open because the nearest hospital is about an hour away in good weather,” said MacWilliam.

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To make matters worse, Northern Health, the authority responsible for Chetwynd Hospital and health care in the northern half of the county, has stopped posting public notices about closures, known as diversions, the 29-year-old said . Instead, they posted to community Facebook groups — with multiple residents posting to Facebook asking for more transparency.

Ashley MacWilliam, whose daughter has asthma, said she should call ahead to make sure the hospital in her town is still accepting patients. (Submitted by Ashley MacWilliam)

Chetwynd is one of dozens of communities to have experienced hospital closures in the past year, and advocates are calling for rural residents to be subsidized for costs associated with the healthcare system they see as unstable.

For example, MacWilliam said access to ambulances in her community has been erratic lately, with wait times of up to 40 minutes — well above mandated “target time” of nine minutes.

“If it’s life-threatening, there’s no guarantee someone will be around to help you,” she said.

Hospital closures – especially without public notice – can lead to vulnerability residents, including seniors, die or be seriously injured, she said, noting that health care facilities are scattered in the region.

The inconsistency can be “really scary,” she said, adding that some family members once had to stay overnight in Dawson Creek because Chetwynd’s hospital was closed.

Northern Health said in a statement it was in a difficult position.

“When the cause of a service interruption is sudden, unexpected, or occurs outside business hours, it is challenging to provide public notifications in real time – including notifications that regular services have resumed,” a Northern Health spokesperson said in a statement.

“Northern Health makes every effort to prevent service interruptions and try to limit their duration…and the impact on patient care when they unfortunately occur.”

Rural residents pay $2K more to access healthcare: study

Jude Kornelsen, co-director of the Center for Rural Health Research at the University of British Columbia, said the cost to BC residents could add up if their primary care provider must be distracted and they must travel.

A peer-reviewed study called “The rural tax” that Kornelsen led found in 2021 that rural residents pay an average of $2,044 in out-of-pocket expenses to access health care, including costs for meals, lodging, and specialty services.

The study, based on a survey of more than 300 respondents, found that they spend an average of $856 on travel and $674 on accommodation.

A graph from a study.  On the left is the average price of a means of transport, on the right is the percentage of respondents who have used that means of transport.  85 percent of respondents spent an average of $554 on gasoline in this study, with the second highest being 32 percent of respondents who spent $155 on parking.
A graph from Dr. Jude Kornelsen’s 2021 report showed that gas and parking were the most common expenses for people seeking health care in rural BC. The researcher is asking the BC government to fully cover residents’ travel costs and improve public transportation options so residents don’t have to pay for housing. (BMC Health Services Research)

“Nearly 60 percent of the people who responded said the out-of-pocket costs or having to travel negatively affected their health,” Kornelsen said in an interview.

“The people of lower socioeconomic status often have a greater need for health services,” she added. “These are the people who travel to access health care, unsubsidised, most affected.”

Less centralization, more autonomy: advocate

Healthcare instability can also take an emotional and systemic toll, said Paul Adams, the executive director of advocacy group BC Rural Health Network.

“I would say rural people in BC believe they’ve been in a health crisis for a few decades,” he said.

And the effects of the lack of investment in health care have gotten worse, he said.

Adams is one of a number of residents, including mayorscalling for a move away from centralized healthcare authorities and greater autonomy for communities.

Centralization “has virtually removed any involvement with residents’ voices within their communities,” he said. “There is a real need to bring rural voices back into the management of their own health.”

These challenges are intertwined with those faced by indigenous peoples in remote areas, Kornelsen said, adding that the government should fully cover transportation costs to and from hospitals.

She said the province should look into that as well strengthen primary caremake outreach clinics like those in rural Australia to enable access to specialists and increase access to virtual health.

A spokesman for the Ministry of Health said the provincial medical services plan offers some discounts on public transportation for people who apply in advance. Northern Health and Interior Health have their own programs with discounted rates.

In addition, the spokesperson said BC’s Practice Ready Assessment program, a pathway for internationally trained general practitioners to obtain a license to work in BC, will triple in size from 32 to 96 by March 2024.

“Half of all program graduates are placed in rural communities through Return of Service agreements; the other half are placed in primary care networks with critical staffing needs.”

The province is also strengthening incentives for support staff and doctors to relocate to smaller communities this year, the spokesperson said.