Every few months, Nicole St-Jean and her nine-year-old son, Vincent, fly to Quebec City from their home in Sept-Îles, Que., to see specialists for issues related to his severe gastric reflux, asthma and allergies.
Their visits often last two weeks because Vincent can tolerate only one or two appointments a day. He has autism spectrum disorder and is sensitive to sensory overload, said St-Jean.
All that time away is expensive and requires a lot of planning.
A few years ago, a hospital social worker connected St-Jean with Hope Air, a national charity that provides free air travel to patients in financial need.
Since then, the charity has covered all of their flights and travel expenses.
Without Hope Air’s help, St-Jean says it would be unaffordable for her to go back and forth to Quebec City.
“We’d have to cancel some (appointments) and try to prioritize which ones to go to,” said St-Jean, who has four other children. “But it would be hard.”
It’s a predicament faced by many Quebecers who need to get medical treatment that is not available in their region.
Although the province reimburses some travel expenses, patients need to pay upfront.
“When you leave, you don’t necessarily have that money in hand,” said St-Jean. “You get it when you come back, but the province doesn’t reimburse the full cost.”
In 2023, Hope Air provided over 400 return flights for patients in Quebec as well as hotel stays, meals and ground transportation.
In flights alone, that “represents close to a 30 per cent increase, year over year,” said Mark Rubinstein, Hope Air’s CEO.
Founded in 1986, the charity helps patients access treatment for a wide range of issues, including cancer, heart disease and Alzheimer’s. More than a third of the patients are children who have to travel because of serious health problems.
In Quebec, the charity typically relies on donations and corporate sponsorship, but growing demand means that without an investment from the province, it may need to suspend or reduce its programs, said Rubinstein.
“We know from our own surveys that well over a third of patients, if Hope Air didn’t exist, would simply cancel or postpone their appointments,” he said.
.jpg?crop=1.777xh:h;*,*&downsize=510px:*510w)
Nicole St-Jean relies on the charity, which helps cover medical costs, to take her son Vincent to see specialists in Quebec City. Their visits are often two weeks long because he can only handle one or two appointments a day.
Travel policy complicated, time-consuming
Most of the patients Hope Air helps come from Rouyn-Noranda in Abitibi or Sept-Îles on Quebec’s North Shore.
Rubinstein says patients typically fall into two groups: people who have trouble making ends meet on a week-to-week basis and those who are struggling with the rising cost of everything from rent, to mortgages to food.
“When you think about the fact that you have over 800,000 people in Quebec using a food bank on a regular basis just to feed themselves,” said Rubinstein. “And then when you’re faced with thousands of dollars in medical travel expenses, that simply becomes unaffordable.”
The travel policy for Abitibi’s regional health authority doesn’t cover flight costs and on Quebec’s North Shore, the province only pays for airfare if the patient lives in a remote area such as Anticosti.
Most patients have to drive but there’s a 200-kilometre deductible for mileage.
“We’re talking about a six-, seven-, eight-hour drive and in winter conditions, even longer,” said Rubinstein.
Hotels and meals are also more expensive than the amount allocated by the government, said Véronique Morneau, general manager of the Côte-Nord’s complaints and assistance support centre, which fields complaints from patients who are dissatisfied with health-care services.
Just filling out all the necessary paperwork and getting the right approval can be complicated and time-consuming, said Morneau.
Once the patient returns, they need to provide supporting documents from both their referring doctor and the doctor they consulted as well as all their receipts.
It can take weeks to be reimbursed.
“Over the last few years, the increase in the cost of living is huge,” said Morneau, who isn’t surprised Hope Air has seen a surge in demand.
Throw in the added cost of taking time off work and organizing child care and some patients decide it’s not worth it.
“Many residents in our remote areas refuse certain treatments outside their region,” said Morneau.
$300K-$500K investment needed
Aside from donations and corporate sponsorships, Hope Air has funding partnerships with most of the other provinces it operates in, such as Newfoundland, Saskatchewan and British Columbia.
Last fall, the charity contacted local officials in both Abitibi and Quebec’s North Shore and sent a letter to Health Minister Christian Dubé to discuss a similar arrangement, but it did not hear back.
The Quebec Cancer Coalition is now working with Hope Air to arrange a meeting.
“We know that we have a big issue with regional equity,” said Eva Villalba, the executive director of the coalition, a non-profit patient advocacy group dedicated to improving the Quebec health-care system for people affected by cancer.
“If we look at not just the incidence of cancer but more importantly, the mortality rates of cancer, they are poorer in more remote and rural regions of Quebec,” said Villalba.
She believes the province’s medical travel policy is outdated and doesn’t reflect many people’s current financial reality.
Villalba also doesn’t think it’s realistic or compassionate to ask people to spend hours driving to a medical appointment.
“What if you have incontinence issues? What if you’re tired? What if you’re in pain?” asked Villalba. “A flight is a way better option, but obviously, it’s not accessible to all.”
Rubinstein estimates Hope Air would need between $300,000 to $500,000 from the province to meet the current level of demand in 2024.
The Ministry of Health said it does not have an agreement with Hope Air, nor are discussions underway.
“If a request is submitted, it will be rigorously analyzed,” said Marie-Pierre Blier, a ministry spokesperson.
In an email, Blier said contrary to what other provinces have in place, Quebec has a program that provides financial support to users, regardless of their income.
Last spring, Health Minister Dubé announced that patient travel allowances would be indexed annually to better reflect economic changes, said Blier.
Patients can also receive a tax credit to help them pay for certain expenses associated with care obtained in another region.