Saskatchewan·Special Report

Regina health region's cardiac rehab 'a program for rich people'

Lyn Goldman, a heart attack survivor, says the Regina Qu’Appelle Health Region’s (RQHR) cardiac rehabilitation program has become “a program for rich people.”

RQHR rehabilitation program five times more expensive than Saskatoon’s

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      The Heart and Stroke Foundation says over the past few months it's been receiving calls from patients complaining about the high cost of cardiac rehabilitation in the Regina Qu'Appelle Health Region. 

      According to the foundation's director of government relations and health promotion, Natalie Gierman, patients and their families have been calling "letting us know that the fees in Regina are really deterring people from either staying in the program or joining the program."

      Gierman said that's a serious concern.

      "Fees should not deter anyone living with heart disease from getting the care they need. That's simply it," Gierman said.
      Lyn Goldman, a heart attack survivor, has been enrolled in Regina's cardiac rehabilitation program for years, and she says the sky-rocketing cost makes it unaffordable for many. (CBC)

      Gierman's concerns are echoed by Lyn Goldman, a heart attack survivor. She says the RQHR's cardiac rehabilitation program has become "a program for rich people."

      Goldman said while she's been able to afford the program for several years she's seen many people walk away because the cost is too high.

      Regina's cardiac rehab program five times more expensive than Saskatoon's

      The RQHR refers 1,700 patients a year to the program, delivered by the Dr. Paul Schwann Health and Research Centre at the U of R.

      It provides patients with an individually designed, medically supervised exercise program. It costs $440 for three months.

      Three months of programming is much cheaper in other Saskatchewan cities.

      Saskatoon's program is $90, Prince Albert's is $73 and Moose Jaw's is $60. In Yorkton, patients pay just $2 per session while cardiac rehab exercise in Melville and North Battleford is free.

      Gierman said even smaller fees like $25 a month can be difficult to afford for people needing cardiac rehab, which she points out, are often seniors on fixed incomes.

      "So when the cost is at a high level the way it is in Regina we know that less people will participate," she said.
      Natalie Gierman, director of Government Relations and Health Promotion for the Saskatchewan's Heart and Stroke Foundation, says an expensive cardiac rehab puts patients at risk. (Courtesy of Heart and Stroke Foundation/Natalie Gierman)

      Goldman said that's exactly what's happening. She said she's seen people who need the program walk away.

      "So what do they do?" Goldman asked. "They either don't go, which is bad for their health or they go to a program where they're not getting the supervision and it's a shame."

      Harold Riemer, the dean of the Faculty of Kinesiology and Health Studies at the U of R, oversees the program. He acknowledges the high price is having an effect.

      "There are people that have left, there's no doubt," Riemer said.

      RQHR cut subsidy to rehab program

      He said Regina's program is pricey "because that's what it costs us to deliver that program."

      Reimer pointed out it wasn't always that way. He said the program, which is a partnership between the U of R and the RQHR, used to receive a $90,000 annual subsidy from the health district.

      But in 2010 the RQHR cut off that funding.

      Reimer said despite that, the U of R kept the price low -- until last fall. At that point, the university concluded it could no longer afford to, and the price was increased from $126 to $440.

      "Our reality is that we have to make sure that we cover our costs -- at least most of them," Reimer said.

      Health Region blames high cost of program on U of R

      RQHR acknowledges it cut off funding to the program more than four years ago.

      Lori Garchinski, the executive director of cardiosciences and critical care, said the money was directed to "programming with greater need," though she couldn't say specifically where that money went.
      Lori Garchinski, the executive director of cardiosciences and critical care for RQHR, said the funding for the cardiac rehab program was directed to “programming with greater need.” (CBC)

      Despite the fact that RQHR refers hundreds of patients to the program every year, Garchinski was unable to explain why the rates were so high.

      "The U of R sets those rates directly in terms of what the costing of their exercise programming is about," Garchinski said. "So I can't comment on their rates. That's a decision made by the U of R."

      Garchinski acknowledged that she doesn't know the cost of the program or how it compared to others in the province.

      In addition, she said she doesn't know how many patients, or which patients, are receiving rehabilitation. And she wasn't aware that some people weren't using the program because of the high cost. She said the U of R doesn't report to the RQHR about that issue.

      Despite all that, she insisted "we believe in the importance of cardiac rehabilitation."

      To demonstrate that, Garchinski pointed out that the region provides free educational sessions about exercise, stress management, diet and medication.

      Experts say cardiac rehab should be publicly subsidized

      Saskatoon physician Patrick Ling, who specializes in sports medicine, said it's not acceptable that patients have to pay for care that is so fundamental to their own well-being.
      Saskatoon physician Patrick Ling, who prescribes exercise as medicine where possible, says patients shouldn't have to pay exorbitant costs for care that is so fundamental to their own well-being. (CBC)

      "If we believe in the universal healthcare model then it is up to, not only those who are established within the healthcare model, such as physicians and hospitals and such but it is also the responsibility of the administratives to recognize that this is an essential component to health care," said Ling.

      Ling said an expensive program could end up hurting the most vulnerable people.

      "There's lots of evidence to say that those who have a lower socioeconomic status have poor health outcomes and if we're creating another barrier, which is cost, to programming, which is, I would say, essential to quality aftercare, then I don't agree with that."

      Gierman said she's disappointed the RQHR isn't subsidizing the cardiac rehab program. "I think the health region should be stepping up in this case," she said.

      She worries that some parts of the health care system may not be taking preventative care seriously enough.

      "People survive and I think that we stop there," Gierman observed. "We're not paying enough attention to secondary prevention. So making sure it doesn't happen again.

      CBC's iTeam asked the Ministry of Health for an interview with the minister about the disparity in rates between the various regions.

      The ministry refused an interview, but in a written statement said "each health region determines the distribution and mix of its health services. The Ministry of Health provides global funding to regions for the delivery of programs and services."


      About the Author

      Geoff Leo

      Senior Investigative Journalist

      Geoff Leo has been a reporter for CBC News in Saskatchewan since 2001. His work as an investigative journalist and documentary producer has earned numerous national and regional awards.

      With files from the CBC's Roxanna Woloshyn


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