Most prosthetic costs are prohibitive due to insufficient coverage, according to advocates
Speaking for amputees in BC, advocates are speaking out on the difficulties of obtaining prosthetic limbs, partly due to hurdles within the healthcare system.
Emery Vanderburgh, a University of Victoria student and co-founder of advocacy group Ampuseek, said she struggled to get funding for a prosthetic leg after losing hers to cancer when she was 17.
“What I found going through the process [of applying for coverage] was a lot of inconsistency with funding, a lot of incoherence, and a lot of confusion,” Vanderburgh told CBC News. “Once I was fitted with my device, I discovered that the technology is over 20 years old and the legs are extremely expensive.”
Coverage for prosthetic limbs differs from province to province. According to the BC Ministry of Health, its provincial healthcare plan covers prosthetic limbs, although Vanderburgh pointed out that coverage is limited to “basic functionality”.
Under the Fair Pharmacare program, applications for prosthetic devices are reviewed to determine how much of the cost will be covered by the province; any remaining costs have to be shouldered by the applicant. Vanderburgh said she was only able to get her device with the help of charitable organizations like War Amps.
Her prosthetic limb cost $30,000, but it has very limited functionality and even walking up and down stairs is a challenge. “I have to walk up one step at a time,” she said. Vanderburgh has been applying for funding for a more high-tech limb, but has been rejected four times.
Annelise Petlock, the advocacy program manager at War Amps Canada, said Vanderburgh’s story is not unusual.
“War Amps does what we can, but we really need to make sure that government agencies and insurance agencies cover the cost of appropriate prosthetic care,” she told CBC News. “[W]e're a charity supported by the public. Our own funds can only go so far.”
According to Petlock, many amputees can’t access the prosthetics they need because of two mistakes among decision-makers: overestimation of how advanced prosthetic technology is and underestimation of its costs.
“We often talk about the Star Wars Syndrome,” she said, referring to how the lead character, Luke Skywalker, got his severed hand replaced with an identically functioning one. Due to such media representations, public and policy decision-makers tend to assume artificial limbs can replicate anatomical functions to a higher degree than they actually can.
Because of that, the devices that fall under the “basic functionality” umbrella in most plans don’t come close to being a serviceable substitute for a lost body part. The more advanced models are expensive, ranging from $75,000 to $100,000 — an amount that doesn’t cover the cost of replacement, which must be done every few years. Since prosthetics can’t be mass-produced, the companies that manufacture them can’t lower costs.
But Petlock has argued that matching amputees to high-functioning devices would be cost-effective since other treatments like massage therapy, pain medication and rehabilitation would be eliminated. Since amputation is not common, she added, it wouldn’t be a huge burden to the healthcare system.
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Emery Vanderburgh, a University of Victoria student and co-founder of advocacy group Ampuseek, said she struggled to get funding for a prosthetic leg after losing hers to cancer when she was 17.
“What I found going through the process [of applying for coverage] was a lot of inconsistency with funding, a lot of incoherence, and a lot of confusion,” Vanderburgh told CBC News. “Once I was fitted with my device, I discovered that the technology is over 20 years old and the legs are extremely expensive.”
Coverage for prosthetic limbs differs from province to province. According to the BC Ministry of Health, its provincial healthcare plan covers prosthetic limbs, although Vanderburgh pointed out that coverage is limited to “basic functionality”.
Under the Fair Pharmacare program, applications for prosthetic devices are reviewed to determine how much of the cost will be covered by the province; any remaining costs have to be shouldered by the applicant. Vanderburgh said she was only able to get her device with the help of charitable organizations like War Amps.
Her prosthetic limb cost $30,000, but it has very limited functionality and even walking up and down stairs is a challenge. “I have to walk up one step at a time,” she said. Vanderburgh has been applying for funding for a more high-tech limb, but has been rejected four times.
Annelise Petlock, the advocacy program manager at War Amps Canada, said Vanderburgh’s story is not unusual.
“War Amps does what we can, but we really need to make sure that government agencies and insurance agencies cover the cost of appropriate prosthetic care,” she told CBC News. “[W]e're a charity supported by the public. Our own funds can only go so far.”
According to Petlock, many amputees can’t access the prosthetics they need because of two mistakes among decision-makers: overestimation of how advanced prosthetic technology is and underestimation of its costs.
“We often talk about the Star Wars Syndrome,” she said, referring to how the lead character, Luke Skywalker, got his severed hand replaced with an identically functioning one. Due to such media representations, public and policy decision-makers tend to assume artificial limbs can replicate anatomical functions to a higher degree than they actually can.
Because of that, the devices that fall under the “basic functionality” umbrella in most plans don’t come close to being a serviceable substitute for a lost body part. The more advanced models are expensive, ranging from $75,000 to $100,000 — an amount that doesn’t cover the cost of replacement, which must be done every few years. Since prosthetics can’t be mass-produced, the companies that manufacture them can’t lower costs.
But Petlock has argued that matching amputees to high-functioning devices would be cost-effective since other treatments like massage therapy, pain medication and rehabilitation would be eliminated. Since amputation is not common, she added, it wouldn’t be a huge burden to the healthcare system.
Related stories:
Denied compensation by insurer, NS man sues to be legally recognized as paraplegic
Over-allocation of medical supplies exposes healthcare inefficiency in Ontario
