After years working in rural health care, the story of a young family living in B.C.’s northern interior still sticks with Dr. Jude Kornelsen.
The closest maternity care centre was a two-and-a-half-hour drive from their home. They had to move there more than a month before their second child was due to manage pregnancy complications.
The woman’s husband worked in resource extraction and had to take time off to care for her and their family while they waited.
They ended up having to stay there two months, paying for temporary accommodation on top of all their bills back home without income coming in.
In the end, they defaulted on their mortgage. With a newborn in tow, the couple was forced to sell their home and find a new place to live close to their family and community.
This story is not unique, says Kornelsen, co-director of the Centre for Rural Health Research at the University of British Columbia.
People from rural and remote parts of B.C. pay an average of $2,234 out-of-pocket when they are forced to travel out of their communities for medical care, a new report from the centre has found.
In the wake of the report, rural health advocates are calling for the next government to reduce costs for rural patients by expanding specialist clinics in smaller centres and covering costs when people have no choice but to leave their communities for care.
“It’s not just getting to the surgery or the birth,” said Kornelsen, who led the survey with four patient partners. “It’s the other things, the specialist visits, the pre-operation testing and the followups that create this huge burden.”
Childcare, gas, accommodation costs and lost wages all add up quickly when people are undergoing cancer treatment, managing chronic conditions or giving birth.
Accommodation costs each patient an average of $674 in their course of treatment, and $777 was average for transportation costs. The three per cent of respondents who flew to treatment spent an average of $1,577 on airfare.
Of 381 patients surveyed between 2017 and 2020, 78 per cent had trouble paying out-of-pocket costs while only 14 per cent of respondents had financial help from an organization.
And paying for these things can be even harder for seniors who retire to rural areas and deal with complicated health challenges in their later years while on a fixed income or pension.
Kornelsen noted that the end of Greyhound bus service in B.C. has driven up costs, causing patients stress about finding a ride to appointments or driving in severe winter weather.
“Travel in the winter from Smithers to Terrace is life-threatening,” wrote one respondent to the survey. “We were almost killed on Dec. 13 when we careened off the icy road after spinning many times down the road and narrowly missing other traffic.”
And even though rural patients rate their care positively, the stress of travel and paying associated costs can have drastic effects on their mental and physical health.
Patients reported avoided seeking care because they knew they would face travel costs they couldn’t afford. Children were hurt, they said, when they were pulled from school to accompany family members to treatment.
The disruption to work, family and community support takes a steep toll, particularly for women from remote communities and First Nations who have to give birth outside their community.
“They essentially have to leave the community for an event that is a course of life,” said Kornelsen. “At this really important and vulnerable time, they have to remove themselves from their support networks.”
Armed with numbers to support the patients’ stories they’ve heard for years, rural health advocates are now calling for the province to take bold action to cover health-related travel costs.
They see the election as an opportunity to push candidates on the issue, particularly in the few hotly contested rural ridings like Fraser-Nicola, won by the BC Liberals by a narrow margin in 2017.
“Not only is it difficult to access services, but sometimes the services just don’t exist at all,” said Ed Staples, president of the BC Rural Health Network. “This survey provides us with the evidence we need to go to the provincial authorities and say ‘Look, we need you to address this problem in legislation.’”
Staples and Nienke Klaver, his wife and co-founder of the network, have seen firsthand how bringing specialists into communities makes a difference.
By 2017, their small community of Princeton had just one family doctor for about 5,000 nearby residents, and the hospital’s emergency department was set to limit hours and then later close.
“It was a crisis situation, it had reached a tipping point, and it really woke up our community,” said Staples, a former music teacher who retired to Princeton 12 years ago.
The Support Our Health Care society of Princeton, founded five years earlier, was able to protest and draw enough attention to the problem to prevent the emergency department closure, and then some.
There are now six full-time family doctors in town and more than a dozen specialists who hold monthly clinics in Princeton so patients don’t have to travel to them.
And the society became one of six founding members of the network, which now consists of 40 organizations and individuals across the province.
Creating the same model in other communities is possible, says Staples.
That should start with providing coverage of out-of-pocket costs for health travel and expenses and directing health authorities to provide more services in smaller communities, Staples said. Support that allows midwives to have sustainable practices in smaller communities is also critical to allow people to give birth without leaving their homes.
Staples and Kornelsen would also like to see health authorities encourage specialist clinics in more rural areas and to leverage the pandemic-driven shift to virtual care to make routine appointments available by phone or video chat options.
The pandemic has affected travel options and how much community support some people may access, and Kornelsen is already planning a followup survey this fall to judge the impacts of COVID-19 on these patients.
At the moment, though, Staples is hopeful change in the rest of the province will come, just as it did in Princeton.
“I’m very optimistic. That’s in my nature I guess.”