Americans looking at Canada’s health care system

Health | Myths, truths of Canada’s universal coverage | Seattle Times Newspaper.

With Obama’s changes going through the American law making system, there’s a lot of talk in the States about Canada’s universal health care system.  It seems odd to me that we should even have the debate about some sort of universal health care coverage.  However, that’s probably just me because I was born and raised in the Canadian system.

Reading the Seattle Times article got me thinking.  Do I know everything about the US system versus the Canadian system?  No.  However, I have my own experience and the experience of others to build up my impression of both systems.  Obviously, I have a huge bias for the Canadian system, but I know it’s far from perfect.  Perhaps Americans who stumble across this post will find the information I provide helpful in deciding whether some sort of universal health care is the way to go.

Living in British Columbia, we all pay our provincial health insurance premiums and we all have our CareCard, a provincially issued health ID card that allows us to access basic medical services.  Even temporary residents must get the card as far as I am aware.  The premium we pay is $54 per month.  If you’re income is below a certain level, you can pay a lower premium or have it totally waived.  As a university student with no income, I did not have to pay any premiums at that time.  Now that I am fully employed, I am required to pay the premium, but my workplace kindly pays for half of it as a part of my benefits.  For more details about the B.C. premiums, you can look at the Medical Service Plan Premiums page.

Obviously, the few hundred dollars per year is not going to cover my full medical bill for any given year, but it helps to give a small price to what we receive.  It’s not totally a free lunch.  I’m not clear whether the Obama health care bill will have premiums or not. I haven’t the time to read through the document in great detail.

Basic Health Care – an example from British Columbia

My medicare basically cover’s all my family doctor/general physician visits.  The only thing I was not covered for at a family doctor was a general physical check up.  I had to pay $50 for that because I was in my 20’s at the time and it was not deemed as medically necessary.  That check up was done in B.C.  When I lived in Ontario, I also did get a check up done, but that was fully covered by the Ontario Health Insurance Plan (OHIP).  So I’ve seen my doctor for a variety of reasons over the years – flus, colds, sore throats, bodily pains, dizziness, etc.  All those visits were covered.

I have heard some talk in American papers on how Canadians cannot choose their family doctors.  That is totally untrue.  In fact, I did visit 3 different GPs during one particular year.  I can’t remember why I did that.  However, I am glad that I did establish a file in more than one clinic because I ended up being unhappy with my original GP and decided recently to move permanently to one of the other GPs.  The other GP had stopped taking new patients many years ago, so I was lucky I had seen that doctor many years ago.  I know some people who move into town, but cannot find a family doctor.  They are forced to walk-in medical clinics where the turnover of doctors can be high.  So each time they go into the clinic, they must re-establish the rapport and their history with the new doctor.

Canada has a severe lack of family doctors.  It seems like everyone wants to be a specialist or practice in the US (higher wages or different opportunities).  Rural areas of Canada are particularly lacking in doctors.  A big metropolitan centre like Vancouver, though, is also lacking.

Sometimes the doctor will refer to a specialist or a medical laboratory for further testing.  I’ve never had to pay at a specialist, like a Ear Nose Throat (ENT) doctor.  When I get an order to have my blood tested, I’ve never had to pay for that.  Any time there is a medical reason for a test or appointment, then there is usually no cost involved to the patient.

There are some things that do cost money, though.  One of the big ones for patients is the prescriptions.  Canadians all have to pay for their prescriptions.  Some people have something called PharmaCare, but honestly I am not that familiar with that since I’ve never had that sort of coverage.  I pay for all my prescription meds.  Apparently, our prices are lower than the US for prescription meds.  However, I would never buy meds in the US unless it were not available in Canada.  I just have not had a need for that so far (knock on wood).  If someone is not well, though, you can imagine the cost could still be very high for a large amount of meds.

I only know of one case where meds were paid for and that was for somebody who had kidney disease.  They had to go into the hospital periodically for kidney dialysis and at home, they had boxes and boxes full of meds that were covered for by the system.  I guess in their case, it was a matter of life and death.  Thankfully, that person got a kidney transplant and is now studying for a new profession.

Also, certain assistive medical products like a braces, crutches, prosthetics, wheelchairs, walkers, etc. are usually not covered.  So people often have to take out their own money for these products.

Hospital visits are almost completely covered.  I’ve been in emergency for stitches a couple of times.  The wait was admittedly long – up to 4 hours.  However, I could go to whichever hospital I wanted.  One time we went to a hospital that we know has shorter wait times.  The other time, I went to the closest hospital just for convenience.  There was no need to call an insurance provider to get pre-authorization for any procedures.  The CareCard was all I needed.  I’ve also had scans and appointments in hospitals.  Those were all covered.  I waited to have an ENT appointment for only a couple of months.  I had specifically requested a particular ENT and the doctor was willing to make that referral.  I also had a colonoscopy for which I waited about 3 months.  For that appointment, I just asked that they send me to whoever was quickest to get in with.  So my family doctor actually sent me to specialist in a different city (but the city is right next door).  To me, those times are definitely reasonable.  However, if I had cancer or something life-threatening, I would probably not wait and actually pay to get testing done outside of the system.

Extended Health Benefits – private medical insurance in Canada

Apart from doctors and hospitals, there are also other paramedical services that may not be fully covered.  Ambulance service is not covered by the medical system.  One could potentially receive a $100 bill from the B.C. Medical Ambulance Service.  One of the most commonly non-covered services is vision.  For children, an optometrist visit may be covered, but for the vast majority of us, it is not covered.  A vision test can be anywhere between $60 to $125 depending on the doctor.  Glasses are then $200 and up from an optician.  Another common service that is not covered is physiotherapy.  If your injury is due to work or a motor vehicle accident, then you could get coverage from workers compensation or from the Insurance Corporation of British Columbia (a provincially run vehicle insurance company).  However, most of us will pay $50-100 per visit out of our own pockets for these kind of services.

For those of us who are employed, we can often join the group extended health plan.  These plans help to cover what basic medicare does not cover.  The largest covered work benefit would be the dental plan.  I pay into my plan so that I can get my regular dental work done and covered.  Glasses can also be covered up to a certain amount by the extended health plan.  My physiotherapy is also partially covered.

So the private insurance companies still flourish within Canada.  They may not cover basic medical and hospital visits, but they cover all those extra paramedical services that are still necessary for a good quality of life.  I imagine if America were to adopt universal health care, they may have a similar set up with basic medical covering doctor and hospital visits and private insurance to cover the other things.

Two-Tier Medical System

One of the big controversies in Canada is whether we should allow a two-tier medical system.  Currently, we are a solely public medical system for basic medical services.  There is talk of introducing private hospitals and private medical clinics to help speed up service.  You could pay to get a test sooner.  Also, that would free up a spot in the public system for somebody else who cannot afford to pay.  Proponents of the two-tier system see this as a win-win situation.

Critics say, however, that would mean that the rich get better service than everyone else.  They also say that money will start to be siphoned away from our public hospitals and service will deteriorate.

Hong Kong has a two-tier medical system.  From what people tell me, they usually choose to wait in the public system rather than paying large amounts of money for almost the same test.  I have also met people who went back to Hong Kong from Canada expecting to get better treatment.  However, those people are not with us any longer.  I’m not entirely sure if the two-tier system is the way to go.  But if I could afford a test that could save my life, I would probably want to do that.  Currently in Canada, we don’t have option all the time unless we go south of the border.

This post is far from an exhaustive discussion of the medical system in Canada and B.C. in particular, but I hope it gives some idea of the situation in Canada.  Americans just seem baffled by our system for some reason.  Canadian health care may not be exactly as Michael Moore portrays it in Sicko, but it’s also not the big, bad socialist system that a lot of Americans think it is.

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