Canadian Medical Tourism researchers “Very serious” about their independence

At what point does normal hospitality become something else?

Chris Breedy promises he'll serve doubles to the Simon Fraser team if they visit Mount Gay. Good Work Chris! Keep 'em happy.

Our story about the Simon Fraser University team coming to Barbados to research medical tourism caused a lively discussion on and off the blog. Folks raised all kinds of questions about the research, how it will be used and about who is funding the research.

On anonymous reader called “One who knows” stated the the Simon Fraser University team already arranged to meet with Barbados government representatives and that the government had plans to fete the Canadians with some tours, dinner at the Hilton and a boat ride with rum punch.

One of the team members, Assistant Professor Jeremy Snyder, wrote back to us (copied at the bottom of this post), answered a few readers’ questions and took a strong stand on his research team’s independence and funding.

We’re impressed! We don’t usually see that kind of transparency and ethics ’bout this rock. Although you can probably buy our own George or Cliverton for a bottle of Mount Gay’s finest, it sounds to us like Professor Snyder and his friends won’t be corrupting their report because somebody bought dinner and took them on a bus tour around the island.

But the discussion does raise an interesting subject: At what point does normal hospitality become something else? Where are the lines?

We’re pretty sure that Professor Snyder and his friends have their own standards and rules and probably the University and the Canadian Institutes of Health Research have theirs too. We don’t see a problem with these folks being particularly approachable for some of the nonsense that might be the case in other areas of business and research.

We don’t know if the researchers have ever been to Bim, but hospitality is done in a certain way here. We want the researchers to feel welcome and to have a good time while they are here working. I mean, why not? (Clive says he can’t understand why they didn’t come in January seeing as they are from cold Canada!)

How about a free villa for a week? Is that okay?

But where should the lines be drawn on hospitality? What if the government provides them with a driver and a vehicle for a day, or the week? What if the tour of the island turns into a sponsored party every evening? What if some of the team members are offered the chance to stay on the island for another week after the research – say at the villa of a government friend who just happens to be away for a few weeks and so the villa is available and wouldn’t be used anyway? Is that okay?

Nobody used to question where hospitality stops or should stop, or when a gift becomes something else, but increasingly Barbadians are becoming more aware of how our society is impacted by not having Conflict of Interest laws, Integrity Legislation or Freedom of Information. Our politicians promised these reforms a dozen or more times in the last 20 years, but they all lied. Hey, cause that’s what they do!

When Professor Snyder and his friends leave, we hope they take back some fond memories of Barbados and Bajans. Heck, if we see them at Oistins on Friday, we’ll buy them a drink ourselves and that’s for no obligation at all on their part.

But when Professor Snyder and his team are doing their research and writing their study, we want them to be alert to how our lack of laws about Integrity, transparency, conflicts of interest and general lack of standards and enforcement in many areas impacts Medical Tourism in Barbados.

Because… the lack of those laws and standards makes a difference. What differences and to what extent? Well, that’s for Professor Snyder and his researchers to study.  🙂

Welcome to Bim, Professor Snyder!

Here’s the post from Professor Snyder…

Dear Barbados Free Press,

We noticed that several of your readers have questions about our research project. Our project is funded by Canada’s main funding body for medical research, the Canadian Institutes of Health Research. We are not receiving any finding from the Barbados government or any company, hospital, business, or other organization in Barbados. Nor have we received funds from any member of the international medical tourism industry.

We are very serious about maintaining the independence of our research. We are visiting Barbados because we study medical tourism. We have read reports that some Canadians obtain medical care in Barbados, and there seems to be some interest in attracting international patients to Barbados. We are interested in hearing from a diverse range of voices and perspectives. As such, we hope to speak with individuals involved in developing the medical tourism industry in Barbados during our upcoming trip there. We are also interested in speaking to individuals who are critical of efforts to attract international patients to hospitals and clinics in Barbados.

Whatever we find during our upcoming research development trip to Barbados, we aim to develop a fair, honest, and accurate account of what we learn about medical tourism on the island. If any of your readers would like to learn more about the kind of research we do, please feel welcome to visit our research website: http://www.sfu.ca/medicaltourism

Sincerely,
Jeremy Snyder, Valorie Crooks, Rory Johnston, and Leigh Turner

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13 Comments

Filed under Barbados, Barbados Tourism, Health

13 responses to “Canadian Medical Tourism researchers “Very serious” about their independence

  1. India, Mexico, Cuba….just to mention a few.

  2. watcher

    Health care in Canada is organized and run on a provincial basis. In the biggest province it is called OHIP (Ontario). All residents of Ontario who are 65 or older get free prescription drugs and all residents of Ontario get free hospital services. If you are in Barbados for an extended period of time you can get a “holiday” prescription that will cover your meds while away. OHIP already covers most medical situations while Ontario residents are away by way of reimbursement based on what the charges would be in Ontario. You are covered for all of these costs so long as you are not away longer than 6 months per year. Canada is a country that looks pretty big but in reality it is 30 miles wide and 3000 miles long. Simon Fraser is almost as far from Barbados as India is where there are all kinds of inexpesnive clincs for medical procedures. The USA is also available to Canadians who want them, at a cost. Many people who travel to the USA and Barbados for that matter get Travel Health Insurance to cover the cost of local hosipitalization as well as medi-vac. Where do the big ups go when they have a serious medical problem?

    The whole cost of this study seems to be a boon doggle. I would suggest the first thing these folks do is go down to QEH and check out the facilities and the wait times in emergency. But then again, it was not that long ago that Barbados was in the thought process of becoming a province of Canada….that would get us all free medical and be part of one of the finest medical systems in the world. Maybe that is under way again.

    I am all for improving health care. Barbados has one of the world leading companies in the generic drug manufacturing business operating on the island. …Biovail located out towards Oistins. Prescription drugs in Barbados should be very well priced.

  3. motive

    It is not the Barbadian work ethic that brings Biovail to Barbados but rather tax advantages that siphon monies away from the same system that allows Canada to have a high standard of care for all citizens.

    Unfortuneately Canada no longer has a balanced budget and is printing billions like the US and other countries.

    http://en.wikipedia.org/wiki/Biovail

    So what was the purpose again of the research junket?

  4. J. Payne

    Canadian companies having a businesses in Barbados does not shield them from Canadian taxation. It just simplifies it a little. As I’m led to understand, if ACME Corporation bases a part of their global operations in Barbados, and they use B’dos as a springboard to trade internationally, then the profits from around the world would be brought (or pooled) into Barbados. If that company goes to export those profits to the parent company in Canada, it comes into Canada as income, and may be subject to Canadian taxation.
    Furthermore, if the company is publicly held, those profits are paid out to Canadian shareholders as dividends. The shareholders themselves must pay taxation on that income as well. IMHO, I believe the Barbadian-Canadian DTA may allow Canadian companies to simplify their balance sheets with regards to paying taxation. Instead of paying taxation all over the place, they just pay tax in one lump sum once brought into Canada, and then shareholders pay the tax on those share dividends also.
    A number of web sites touting the benefits of doing business from Barbados also claim that Barbados’ regulation for Canadian companies (working offshore) is almost directly copied from Canada’s regular act for companies there. So essentially, once a Canadian company knows the rules and regulations of doing business in Canada, it is supposed to mesh almost exactly with Barbados’ offshore rules. (Thusly there’s supposed to be little-to-no learning curve for Canadian businesses.)
    Its really a corporate slight of hand… Not to mention, those dividends going back to Canada will look a lot more juicy before the shareholder taxes are paid on those earnings.

  5. watcher

    @J Payne.

    You say “may pay tax in Canada” but if things are set up correctly then the income flowing to Canada is tax free to the Candaian company, and in Barbados is paid at a maximum rate of 2%, but mostly at 1%. Not much tax at all. IN addition many of the expenses of residing in Barbados to run the IBC are paid for by the IBC. The legislatiion for this was introduced in Canada by a former Prime Minister Mr. Paul Martin. He was Minister of Finance at the time. What is notable is that after it was introduced and put into place the head office of his family business Canada Steam Ship Lines was moved to Bridgetown Barbados. Most Canadian companies operating in Barbados do so under a IBC licences issued by the Barbados Governmnet.
    Here is how it works. A company is incorperated in Canada that own the shares of a company incorperated in Barbados. The Barbados company most have a board of directors that is controlled outside of Canada and must hae one Barbados resident on the Board. Minimum requirment is 3 directors. The Barbados company can not export any of its product back to Canada but can conduct business with other countries. International profits are gathered in Barbados and the Barbados income tax paid on them at the rate of 1% or a maxmium of 2%. The profit after tax is considered by the Canadian Tax legislation as “exempt surplus” and it can be dividended back to the Canadian company that own the Barbados IBC without payment of Canadian Income Tax. Once back in Canada the money can be advanced to other corporations in the group for Corporate use or investment use. The Barbados government charges about $1000 per year for the IBC licence.
    It is a very good deal for the participants, but a bad one for both countries who are trying to collect tax to provide services to the residents.

  6. paul

    Hmm, sounds bad for Canada but good for Barbados. If those Bajan laws weren’t in effect the offshore Canadian companies would never set up here at all. So Barbados benefits to the extent of receiving 1 or 2% of a company’s profits without having to provide any infrastructure – and it sounds like a few Bajan lawyers and accountants generate some fees. It should only happen on a vastly increased basis!

  7. watcher

    @paul

    The point being if you made the tax payable in Barbados say 5 to 10%, there would be a better sharing of the windfall profit. The Barbados government is giving away something for almost free that they could get a lot of money for. Collecting profits at 5% to 10% would be much better than 1 to 2%. The Barbados economy is exactly flush with cash these days and a bigger slice of this pie could help the Government pay for prescription drugs and other services.

    If the change in rates were made, nobody would run away.

  8. watcher

    is “not” flush with cash

  9. J. Payne

    @watcher. Yes. However keep in mind, although the Canadian companies is only paying 1-2% that additionally savings must only be expatriated back to Canada and offshore companies in Barbados are supposed to file matching tax reporting documents to their home country. When that money is brought back out it will be a lump sum that gets hit by Canadian taxation.

  10. J. Payne

    @watcher. Furthermore Canadians aren’t losing a thing because look who dominates the majority of Barbados’ commercial banking system. Scotia, First Caribbean(CIBC), and RBC are gaining profits from these employees of the offshore companies.
    It is only a wheel turning.
    Canadian banks dominate Barbados financial sector, and now the power company is majority Canadian owned too. So how much of any dribbled out money do you seriously think remains in Barbados? Anybody in Barbados with electricity in their home is paying profits back to Emera (http://www.emera.com/en/home/ourbusiness/overview.aspx ) of Canada all the time too. The after financial the only multi-million dollar industry Canadians don’t dominate in Barbados is prob. telecommunications (which is a UK company.)

  11. J. Payne

    @paul Barbados has to compete with other nations that have a similarly low tax rate. (i.e. Cayman Islands, Bermuda, British Virgin Islands, U.S. Virgin Island, Bahamas, Turks and Caicos Islands, etc.) What Barbados gets out of it is lower unemployment. Some of these companies hire locals and those company would be paying the wages of some Barbadians. Canadian companies gain by having more employed in Barbados thus returning better profits than if Barbados has less people employed…

  12. watcher

    @j payne

    For the record once the trax is paid in Barbados (at a maximum rate of 2%) the remaining profit, referred to as exempt surplus can be dividended out of Barbadpos to the Canadian owned Corporation without futher taxation in either Canada or Barbados. Here is the way it works. The main Canadian Corporation incorperates another corporation in Canada and this company owns the company in Barbados. The Barbados company must be controlled by a Board of Directors that are not by majority Canadian thus the Barbados company is not a Canadian controlled Corporation. There must also be one Barbados resident on the Board. Profits are pooled into the Barbados company , knows as a IBC, from transactions that are made outside of Canada or profits on goods exported from Barbados. Neither company can sell in their domestic markets. Profits are sent by way of dvidend to the Canadian company without any further tax. The monies once back in Canada are then advanced to the original corporation who can use the monies for financing etc. The monies advanced to the original corporation is not income to them. This situation is unique for Canadian companies. There are 2 islands where this Canadian legislation can be undertaken….Barbados is one of them. The other one of the islands is mentioned in your response to @paul . Follow the Canadain Banks and you will see where it is or better still google Canada Steamship Lines Barbados and you will see how it all came about.

  13. J. Payne

    @watcher (quote)The Barbados company must be controlled by a Board of Directors that are not by majority Canadian thus the Barbados company is not a Canadian controlled Corporation.(end quote)

    I’m wondering if perhaps you misspoke? Are you arguing that this board of a Barbados based company cannot be Barbadians (nor Canadians)? Because offshore companies as I read can’t be mainly Barbadian and be tax exempt… And they are not supposed to sell and products and or services to Barbadians (nor CARICOM residents)

    AGREEMENT BETWEEN CANADA AND BARBADOS FOR THE AVOIDANCE OF DOUBLE TAXATION AND THE PREVENTION OF FISCAL EVASION WITH RESPECT TO TAXES ON INCOME AND ON CAPITAL — http://www.treaty-accord.gc.ca/text-texte.asp?id=102234

    Under ARTICLE X,
    Section 1 of the Canada-Barbados DTA reads: “Dividends paid by a company which is a resident of a Contracting State to a resident of the other Contracting State may be taxed in that other State.”

    So for clarity: Dividends paid by a company which is a resident of a Contracting State (Barbados) to a resident of the other Contracting State (Canada) may be taxed in that other State.(Barbados)

    Section 2 of the DTA reads: “Dividends paid by a company which is a resident of a Contracting State (Barbados) to a resident of the other Contracting State (Canada) may be taxed in the first-mentioned state (Barbados), and according to the law of that State; but where a resident of the other Contracting State (Canada) is the beneficial owner of the dividends, the tax so charged shall not exceed 15 per cent of the gross amount of the dividends.”

    Section 4 of the DTA reads: “The provisions of paragraph 2 shall not apply if the recipient of the divi­dends, being a resident of a Contracting State (Canada), carries on in the other Contracting State (Barbados) of which the company paying the dividends is a resident, a business through a permanent establishment situated therein, and the holding by virtue of which the dividends are paid is effectively connected with that permanent establishment. In such a case, the dividends that are attributable to that permanent establishment shall be treated as if they were business profits, and the provisions of Article VII shall apply.”

    Also keep in mind Barbados does not have a capital gains tax. (Locals or otherwise.)
    The reason these companies are not allowed to sell services in Barbados or CARICOM is because then all local companies of Barbados could sign up to be one of these companies and pay the 2% as well instead of the former 40% at the time.