Health care Canada vs US - Experiences, Truths, Myths (insurance, house)

[Cornerguy1]

First, a small primer on who is responsible for what in the Canadian healthcare system.

The first misconception is that there is a Canadian healthcare system. In actuality what exists are 13 different healthcare systems each administered by a provincial or territorial government. The role of the federal government in the system is only to set overall standards and to provide funding top-ups with federal funds.

So there is no seamless, integrated system countrywide. A service which may be covered in Ontario, may not be covered in another province, etc. In some provinces, people who make above a threshold income level are required to make a financial payment to the healthcare system. In Ontario, I believe the threshold income is around $20,000 and the minimum payment is $200/year.

Here's how the system usually works.

Every citizen and resident is issued some form of health system identification which they present when requesting covered services. Covered services likely vary from province to province, but include as a minimum items such as doctor visits, hospital care and non-cosmetic surgeries. doctors and hospitals may only bill the health system a set, pre-determined amount for any particular procedure.

In Ontario, dentists, chiropractors, orthodontists, etc, are not included in the health plan. Their fees must be paid privately and they may charge whatever fees they wish. Keep in mind that a large number of workers have private medical benefit plans through their employer which may cover portions of those expenses.

Fees are usually in line with those in the US. For example, the cost of a recent dental check-up including cleaning and X-rays for our family of three was $310. Waiting times for these health care providers are usually quite short, but will depend on the individual doctor and his/her patient load. For a dental emergency like a lost filling, seeing my dentist within 48 hours is no problem.

Optometrists in Ontario used to be fully included in the healthcare system, but are now only partially covered. Visits to the eye doctor for children under 18 are fully covered, but adults are on the hook to pay for their eye exams. Last visit left my wallet $45 lighter.

For most people, eyeglasses, and prescription drugs are not covered by the healthcare system. The exceptions would be low-income earners who qualify for subsidies. Again, private insurers may make up the difference.

In Ontario, once a person reaches the age of 65, most prescription drugs are available free or for a small ($5-10) dispensing fee.


When it comes to the availability of health care, location seems to be the key. Many doctors prefer remaining in larger, urban areas where more advanced medical facilities and greater social opportunities exist. This has led to a shortage of family doctors and specialists in smaller towns and rural areas. Wait times for appointments for non-urgent items can sometimes be several weeks, or you could have an appointment for the following day. Lean to toward the longer rather than the shorter, though.

For those without family doctors, and there are many, walk-in clinics are available in most areas for needs which don't require an ER. Often, patients will get frustrated with not being able to get an appointment with their family doctor in a timely manner, and will instead go to a walk-in clinic.

The Canadian healthcare system can be a very frustrating thing to deal with, especially if a family member is ill. It definitely isn't healthcare on demand. At times it can seem as though those involved in providing care have forgotten about the needs of the patients, but somehow the system still seems to pluck those in real need out of the pond and attend to them.

The one fundamental principle which has been maintained is that physical need is the determining factor when assigning services, rather than ability to pay.

Make no mistake, though, the system eats up a tremendous amount of funding for the service it delivers. It seems to be in a state of constant overhaul with greater effeciency being the goal.

Appointing bureaucrats and commissions to find efficiencies is an oxymoron to many.


There has been talk in recent years of allowing doctors to accept a certain number of private-pay patients similar to systems in countries like Germany, but those proposals are met with stiff resistance from those who believe it would be the beginning of the end for universal coverage. Proposal when in patients would pay a small user fee each time they accessed the system have also been made, but again have been met with resistance.


The system certainly isn’t perfect and it will face some continued challenges in the face of an aging population, but, if given a choice, most Canadians would likely prefer it to a total user-pay system.

[MoMark]

Originally Posted by dreameyes

There are definately walk in clinics in Edmonton that I know of. In fact the doctor that I went to on a regular basis worked in a walk in clinic.
I burned my finger really bad once and had to go to the clinic to have it wrapped. I went there actually several times without appointments.
Eye doctors! Worse than medical doctors. My eye appointments always had to be booked about a month in advance.
Dentists about the same as doctors. Usually 2-3 weeks.

DullnBoring is right about Urgent Care clinics. They're wonderful! They're also cheap and you can get looked at for flu symptoms, coughing issues, cuts, burns...most of the things people go to emergency for. Going to emergency will cost you big bucks and you sit in a waiting room with dozens of other people who are probably infecting you as you wait with something you didn't have before you walked in. Emergency rooms are like giant petri dishes...ugh...I always get the creeps walking into one. I had no choice in May, but that was the first time my adult life I had to do it for me instead of someone else.
Going into Urgent Care is a wait, but it's pretty quick. A lot more efficient and cheaper than an emergency room. If they can't handle you, they'll send you to emergency anyway. (one of my best friends here is a medical doctor who is the head of Urgent Care for Springfield )!
As for eye appointments... go to Sam's Club!!! Seriously! I've gone there for my eye checkups and new prescriptions and it's so cheap I don't even use my insurance. They check for glaucoma and all the normal eye diseases. And my glasses I bought there are "cool"

[dreameyes]

Cornerguy that was an excellent post and quite eyeopening. We do need to remember that most of what we read here are experiences of one individual. The US and Canada are both very large and diverse countries and each province/state is bound to have differnces even though it's the same country.

[ontheroad]

Thanks for pointing out that (a) individuals have differing experiences with the same health care system and (b) services are provided differently in various provinces/states.

Although dullnboring and MoMark talk of Urgent Care clinics--I have never encountered them in my home town. People have always been forced, so to speak, to use Emergency Care facilities.

Originally Posted by dreameyes

Cornerguy that was an excellent post and quite eyeopening. We do need to remember that most of what we read here are experiences of one individual. The US and Canada are both very large and diverse countries and each province/state is bound to have differnces even though it's the same country.

[kitty71]

My WORST experience with Canadian health care was when I slipped and fell on the ice when 4 months pregnant. I thought my water broke (this is embarrassing, but if you have been pregnant you can figure out what happened) I drove myself to the ER, and although I was taken up to a suite immediately, I waited two hours and there was no doctor "FREE" to "check" me to confirm one way or another. This is because they were severely understaffed due to cost. I was beside myself thinking I might lose my baby. I ended up calling my husband and at the suggestions of the nurses, HE DROVE ME to my family doctor's through a blizzard so she could check me. Apparently there were no ambulances available. To this day I think what might have happened if my water had broken and I started to have problems in the car? etc. etc. you can imagine the complications.

So, that was pretty BAD.

OK, now this will be weird, because my BEST experience is also related to childbirth - same pregnancy, too.

To date, my BEST experience with the Canadian system was the magnificent care I received giving birth to my second daughter. I had been in labor for 20+ hours and my doctor visited me a minimum of three times (could be more, I was a little out of it, LOL - as an aside, my first labor of 33 hours she came every 4 hours, then stayed for the last 3 - that's dedication I have yet to see from a physician here).

In a nutshell, I needed an emergency C-section, and my daughter needed emergency care as soon as she was out. She was in the NICU for three days, and I was in the hospital for almost week. My doctor said I could stay as LONG AS I FELT I NEEDED TO (and I DID need to as it turned out). No pushing you out in a day or two.

The surgeon was great, any doctor I have seen since says it is the least noticeable c-section scar they have seen. Follow up visits from nurses, etc. etc. etc.

AND NOT A PENNY did I pay for any of this. I KNOW there would have been probably some high costs for this in the US.

And this is GREAT. So I can see how a person only experiencing ONE of these incidents would have a totally different perspective of how the system works.

When I have more time I will tell of my best and worst US experiences (don't worry, not to do with childbirth this time, )

I'd like to hear some more from others too.

[ColdCanadian]

Originally Posted by dullnboring

1. I do not have a family doctor here in U.S. If I ever have to go to the doctor, which is rare (twice in five years), I go to an Urgent Care facilitiy, which is basically like a Walk-In clinic, pay my $20 co-pay, fill out some forms and will see a doctor that day (the wait time varies from 30 minutes to a few hours), be examined and then sent a bill a few weeks later (I have health insurance). Do such facilities not exist in Canada? I mean, if you are in the moment feeling very ill, are there places outside of ERs where you can go and be seen by a doctor within the same day or is that unheard of?

2. How do dentists and eye doctors fit into the mix? Is it the same level of difficulty to schedule an appointment.

1. You need a family doctor in Canada is you want services from a hospital.

Walk-In Clinics are different. I've been prescribed allergy medication a at a Walk-In Clinic and I was pleased with the results. When I broke my arm, I went to the Walk-In first and had them make me a cast. (I had to wait over 3 hours though) Walk-In Clinics are 100% free for regular Canadian residents. The only "billing" is to OHIP from the Walk-In Clinic itself. (Ontario Health Insurance Plan)

2. Dentists and eye doctors are totally different. I've been able to book dental check-ups within days.

Eye-doctors, I've been able to see them within 2 hours, no appointments neccessary. They are practically on demand (and out-of-pocket) care.

[Cornerguy1]

1. You need a family doctor in Canada is you want services from a hospital.

Judging by ColdCanadians reference to OHIP, I assume he/she is an Ontario resident.

The system may be different in other provinces, but in Ontario you do not need a family doctor to receive services from a hospital.

Hospitals in Ontario draw their physicans from 2 sources: doctors that work strictly at the hospital; and doctors who maintain a private practice, but who have admitting privileges at the hospital in return for doing a certain amount of work there.

Only a doctor who has admitting privileges can book a patient into a hospital.

If your family doctor mantains admitting privileges at a hospital, then he/she has the authority to book you into that hospital.

If you have no family doctor, or if your family doctor chooses not to have admitting privileges, then you will have to be admitted by a doctor who does have that authority. In a crisis, that would likely be an ER doctor, or in the case of a chronic ailment, perhaps by a specialist to whom your family doctor has referred you.

Once in hospital, if your doctor has privileges, then he/she can directly attend to your care by ordering tests, procedures, etc.

Patients who are admitted through the ER and who are without family doctors receive their care from physicans attached to the hospital. Those doctors are assigned patients on a rotational basis.


A sad trend in some rural areas has family doctors opting to not maintain hospital privileges because those doctors may feel covering ER night shifts is intrusive in their lives, because private practices require all their efforts, because they feel they are not being suitably recompensed for their hospital work, etc.

While it is easy to understand why a physican would not relish the idea of spending a night a week away from family, the trend of opting out is further straining hospital ERs.

It forces small, rural hospitals to scramble just to find enough doctors to cover their ER shifts, while at the same time putting more patients through those ERs because that is the only avenue for the patients of non-privileged doctors to be admitted.

[geos]

Originally Posted by kitty71

I thought, seeing that health care seems to come up in every other thread, perhaps it would be a good idea to start a separate thread where people can tell about their own or relatives'/friends' experiences.

Here's an interesting perspective: http://news.yahoo.com/s/ucru/20070117/cm_ucru/250000000insuredbutstillintrouble (broken link)

The Healthcare Crisis for the Rest of Us

NEW YORK--Some people are just cheap. Others are playing the odds, reasoning that paying for doctors and prescription medications on an ad hoc basis will prove cheaper than the $500-plus per month they'd have to shell out for health insurance. But most of America's 47 million uninsured live and die without coverage because they can't afford it. Worse than a national scandal, our failing healthcare system is an international disgrace. Hundreds of thousands of Americans are so desperate that they travel overseas in order to leech off socialized medical care systems, which are prevalent in other industrialized nations.

"We are overwhelmed by you (expletive deleted) Americans," an exasperated emergency-room physician at a Canadian hospital across the border from upstate New York told one of my friends, whose girlfriend had driven him the eight hours from Manhattan to Quebec after he'd fallen down some stairs and broken his arm.

We are Canada's Mexicans.

Fortunately we have our first chance to fix the sorry--more like non-existent--healthcare system since 1993, when the Clintons botched things up with a convoluted scheme designed to protect insurance industry profits. Democrats won control of Congress with two promises: getting us out of
Iraq and fixing healthcare. A USA Today/ABC News poll conducted two weeks before the midterm elections found 80 percent dissatisfied (60 percent highly dissatisfied) with the staggering cost of healthcare.

Staggering it is. In 2006, insurance premiums for an employer-sponsored health plan for a family of four averaged $11,500, more than the net annual salary of a full-time employee who earns $8 per hour. Americans pay over $2 trillion per year--four times the federal defense budget--on a healthcare system that sucks. And the cost keeps going up, two to three times faster than inflation.

Even the Republican Party, hard-wired to anything that might end up helping someone who needs help, is starting to take notice.
Arnold Schwarzenegger, the centrist Republican governor, got such a boost from his proposal to provide insurance to California's 750,000 uninsured children, including undocumented illegals, that he expanded it to cover adults as well. As the New York Times editorialized, "putting children first is a good start, because they are usually healthy and cheaper to cover."

It's obviously outrageous that tens of millions of citizens of the wealthiest country to have ever existed in human history are one cluster of metastasizing cells away from bankruptcy. Did you know that 25 percent of mortgage foreclosures result from high medical bills?

But there's a second, even bigger healthcare scandal that no one ever talks about. There are 250 million other Americans--those of us "lucky" enough to have health insurance--who aren't much better off than the uninsured.

Workers and employers pay an average of $465 per month each to insurance companies who use every shady trick in the book to avoid paying out claims. Pre-existing condition? Not covered. Don't want to drive hours to see a doctor who belongs to your plan? Pay out of pocket. Suffering from an unusual condition that requires the expertise of a high-priced specialist? Denied. You might think a chronic condition calls for long-term care, but to a claims analyst it's merely another excuse to refuse to pay up.

Every now and then, you luck out. Odds are, however, that your deductible will eat up your payout.

When an insurance company hack can't invent a legitimate excuse to turn down a claim they do it anyway. They play the odds, assuming that most petitioners, baffled by Byzantine voicemail trees, impenetrable websites and endless wait times, will be too discouraged to pursue appeals to rejections of their rightful claims. They want you to simply go away.

Let's not even talk about vision or dental plans, which have become rare benefits offered by fewer and fewer employers. Hey, it's not like eyes or teeth are important.

Even the military, which uses healthcare coverage as a recruitment tool, is welching on its duty to treat illnesses--even those it causes. In December 2005 Private Bradley Brown went to an Army doctor at Fort Sill, Oklahoma, complaining of back pain. Brown told the South Bend (IN) Tribune that "the doctor gave him an anti-inflammatory nonsteroid prescription for Naproxen and shot dye into his veins for radiographic (X-ray) studies."
[EDITED]

[passdoubt]

Comparing my experiences with healthcare in Philadelphia with my girlfriend's in Scarborough, Ontario, we didn't find many differences. It takes around the same time to see a doctor from my experience. My mother has osteoporosis and her doctor's office went bankrupt-- holding her records and causing a lot of headaches for her as she had to threaten to sue to get them. I can't imagine this kind of scenario in the Canadian system.

I understand that Canada has a lot of problems with healthcare in rural areas, but the system in suburban Toronto had never given my girlfriend any significant problems.

[NYSinger]

I think the US Healthcare can be great if you have a good insurance. It will be a lot less pricey than having a bad insurance or none at all.