“The Canadians, when they need a big operation, when something happens, they come into the United States in many cases because their system is so slow.”
— Donald Trump, second presidential debate, Oct. 9, 2016

During the health-care policy portion of the debate, Trump attacked Hillary Clinton’s health-care plan and said it would end up in a “disaster, somewhat similar to Canada.” He called the Canadian health-care system “catastrophic,” and said that in “many cases,” Canadians are coming to the United States to receive operations because their system is so slow. We checked out whether this was accurate.

The Facts

Canada has a government-funded national health insurance program and all Canadian residents are guaranteed under federal law to “have reasonable access to medically necessary hospital and physician services on a prepaid basis, and on uniform terms and conditions.” The provinces and territories administer and finance their statewide health insurance plans. About two-thirds of Canadians purchase private insurance to cover services excluded from the government insurance, such as prescription drugs and dental and vision care.

There are longer wait times in Canada than in the United States for people to receive specialized care. According to a January 2016 report by the Commonwealth Fund, 41 percent of adults in Canada in 2013 were able to access same-day or next-day appointments when they were sick, compared with 48 percent in the United States. Emergency, urgent and primary care are prioritized for patients.

But when it came to specialists, 29 percent of adults waited two months or longer, compared with 6 percent in the United States. In Canada, 18 percent of adults waited four months or longer for an elective surgery, compared with 7 percent in the United States.

The most comprehensive report on this topic was published in 2002 in the peer-reviewed journal Health Affairs. While the data is 20 years old, it gives us a reference point of how many Canadians who needed medical procedures came to the United States to get them. Of the 18,000 respondents to the 1996 Canadian National Population Health Survey, 90 people said they had received health care in the United States in the previous 12 months. Only 20 respondents said they traveled to the United States specifically to get that care.

The Trump campaign cited research from the right-leaning Canadian think tank Fraser Institute, which found that in 2014, more than 52,513 Canadians received non-emergency medical treatment outside of Canada. The campaign pointed out that 52,513 people in 2014 represented a 25.5 percent increase over the 2013 estimate of 41,838 people. For context, 52,513 people represent 0.15 percent of the country’s population of 35.5 million in 2014.

The report acknowledges there is “no readily available data on the number of Canadians traveling abroad for health care.” Researchers came up with an estimate by using data from the think tank’s annual survey of Canadian physicians in 12 specialties, combined with data on the number of procedures performed in Canada. The specialized areas they surveyed include plastic surgery, neurosurgery, urology, gynecology and oncology. These procedures were “medically necessary elective treatment,” the report said, though there is no information about exactly what procedure these patients would have received.

The study does not look specifically at Canadians traveling to the United States. The survey asks physicians to estimate the percentage of their patients who received non-emergency medical treatment outside of Canada, rather than asking the question of patients. And it does not ask about a motivation for why Canadians traveled abroad. The report says that one explanation for Canadians traveling abroad may relate to the longer wait times that patients face for medically necessary elective treatment.

Unlike in the United States, appointments in Canada for elective and specialist procedures are determined by priority and need, rather than people who can afford to pay more to see a doctor quickly. While it is true that there are longer wait times in Canada for such procedures, there is no reliable, official data on the number of people traveling from Canada to the United States, said Victor Rodwin, health policy and management professor at New York University’s Wagner School of Public Service.

“What we do know is that the numbers of people who come from Canada to the United States for surgery are very small,” Rodwin said.

The Pinocchio Test

This is a classic case of Trump focusing on raw numbers with limited information to extrapolate a general trend. By one estimate by a right-leaning Canadian think tank, there were 52,513 Canadians (0.15 percent of total population) who traveled outside of the country (not necessarily to the United States) to receive non-emergency medical care. This figure was reported in a survey that asked physicians, rather than patients themselves, to estimate how many patients traveled outside of the country. There is no information about exactly what procedure these patients may have received, and it did not ask specifically why the patients traveled outside of Canada for care.

There is limited reliable information to support Trump’s claim. The most comprehensive report uses data from 20 years ago, and found that 90 out of 18,000 people surveyed for the Canadian National Population Health Survey said they had received health care in the United States in the previous 12 months.. Trump’s exaggeration of this one data point to extrapolate a larger trend earns him Three Pinocchios.

Three Pinocchios

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