Health Care Non-American Style

I went looking for some general overview of Ontario health care system, but couldn't immediately find it. So I'll just get the ball rolling with some things that I know about it:

-Every citizen of Canada is entitled to free elementary health care -Every Canadian citizen does not have adequate access to the health care system, often due to lack of doctors and/or facilities, especially in remote areas -Each province administers (and makes the rules for) their universal health care system, but... -Funding of the systems comes from the federal government, and this causes much strife between the provinces and the feds -In Ontario, funding for the system comes in part from EHT (Employment Health Tax) a percentage of an individual's income collected from employers. However, individuals are still covered whether they are employed or not. -In Ontario, dentistry (unless performed in a hospital) has never been covered, and now neither is optometry -Drugs, unless administered by a doctor, are not covered. Therefore, if you have something like diabetes and no private health insurance, you pay for your own insulin, etc. -Some non-covered aspects are heavily subsidized: for example, EMS. You pay $25 for a ride to the hospital, which certainly doesn't cover all the costs. -There are a few exceptions to this. I know from personal experience that the system kicks into high gear for cancer patients -- drugs, EMS, home care by both RNs and specialist doctors, hospice, etc., are all covered.

<bookmarking> Good questions, Swimpy.

Thanks, Tico. Do you think the non-covered items, such as prescription drugs is causing a major hardship for some people?

like tico, i'm canadian

some companies offer medical benefits for prescriptions, dental and eye care

all in all i'd rather try and raise the cost of prescriptions, than the cost of major surgery

dj, some prescriptions cost a lot of money already.

I realize that any large-scale system is going to have some problems. I agree, dj, that raising money for drugs should be easier than rasing money for chemotherapy or some catastrophic illness.

The US has universal health care. Those who don't have insurance can go to the emergency room and get treated. It's not a very efficient way to provide that treatment though.

My yearly physical, chest x-ray, mammogram, blood work, pap, specialist, etc are all covered. So was my three-month hospital stay in 1987. I might still be paying if it hadn't.

Prescription meds for the uninsured can cost an arm and a leg it's true. Those on social assistance, though, and seniors, do receive coverage for many (not all) prescriptions, so in theory, the truly disadvantaged do receive the care they require. There's a schedule. I think it's the newer medications, generally, that take forever to get added.

Even in urban areas in recent years it appears that finding a family doctor accepting new patients is just short of impossible. More and more folks appear to be resorting to walk in clinics.

I only have anecdotes, no facts. I know a woman who has MS and her 12 year old son has diabetes -- meds are costing her $1600 per month. That's about $19k per annum, post income tax dollars, for the rest of her life. She desperately would like to find a job with medical benefits to cover this, in whole or in part.

hmmm ... I'm not sure about the "rest of her life" bit. I think, but could be wrong, that if she and her son live to retirement age the meds may be subsidized then.

And on second thought, the "post income tax dollars" is not absolutely correct either, as she (and all Canadians) can claim a tax refund for medical and dental costs paid out of pocket. But that is a small percentage of the total cost.

As you point out, Swimpy, Americans also have universal health care, of a form. In practice, I'm not so sure that it's so very different for the less privileged of either country. Our emergency rooms are overloaded with cases that could have been avoided or treated, if people had access to GP doctors.

In the States, do you pay to see a GPs (i.e. general practitioner or family doctor)?

And, here, many specialists in private practice or clinics, cardiologists and psychologists for example, are covered by health care if you are recommended by a GP. You can see them without a GP recommendation, but then you pay their fee. So, it becomes very important to have a family doctor.

If you have no insurance and are not on Medicare or Medicaid, you would pay the entire cost of a doctor visit. Insurance coverages vary, so you may have a deductible or co-pay for each doctor visit.

The only State in the US that has "Universal Health Care" mandated by law is the Commonwealth of Massachusetts. In this State, all residents must be covered. Insurance can be bought through the State for premiums that are dependent on your salary and your age. Above the age of about 50, the premium ( as far as I can recall) is about $500+/month.

If you can not afford any type of health insurance, you can apply for Medicaid, which can then be used to pay your health bills.

Medicaid is for the very poor and is not the same as Medicare.

If you lack health insurance and walk into an ER you will be medically treated , stabilized, sent on your way and then billed. Nothing is free. You will have to work out some sort of pay arrangement with the hospital.

If you never pay your bills, you stand a good chance of ending up in Court or having bill collectors knocking at your door night and day to get the money. Moreover, failure to pay your hospital bill will lower your credit rating.

( This is almost standard policy in Boston area hospitals.)

There are plenty of people who live with this situation daily. Not all of the poor are covered by Medicaid, Miller. The working poor can't get welfare.

In Germany (I'm sure Walter knows best how it is today)
everyone is insured. When working, employee and employer pay 50/50
into the healthcare system and receive complete coverage for dental,
eye care and physical. Sick days are paid by the employer up to 6 weeks,
after that the state takes over. Children are insured with their parents at no
additional cost. For the unemployed, the state takes over the premiums.

When I was living in Germany, there weren't any co-pays, but I understand that now there is a 10 Euro co-pay for physicians and for prescriptions.

Germans can choose their own primary care physician who in turn will
write a referral for a specialist if needed.

It seems though, there aren't enough physicians around in Germany. Waiting rooms are crowded and procedures (if not an emergency) are dragged out for months on end. Patience is the name of the game.

2 years ago, physicians were striking for better salary terms and working conditions (mainly in hospitals). I believe their pay was in the lower brackets in comparison for being on call for too many hours and having
a tremendous responsibility towards patient care.

Miller is quite right. You will be billed, and ER visits tend to be quite high, unless you have the kind of income or assets that make the insurance question irrelevant, which group includes very few people. If the hospital can't collect the bill, they are going to expense it for taxes. They can only do this if they have diligently tried to collect the bill. In practice, the bill is turned over for collection, the collection agency obtains a judgement, and ultimately, the patient either files for bankruptcy or has his wages garnished.

As Calamity Jane said.

Er... I think I'll stay in Canada. As long as I have a Health Card (as any person of legitimate citizenship does), I can walk into any hospital or GP, and most clinics, without cost for essential care. When Canadians complain about high income taxes, they forget about this benefit.

Wait times for procedures are an issue, but they are working on that.

Another anecdote: I have a friend in Vancouver, who is an American citizen, now a widow of a Canadian (which is why she's in Van), with 3 children, one of whom has developed lupus. She has considered returning to the States, but has decided that she cannot afford to do so -- because of the ongoing costs of her child's care.

Because she is an intelligent and valuable member of her community, and is raising very committed and intelligent children, that's your loss and our gain, I'm afraid. I guess you could chalk that up as another cost of not having universal health care.

as i've stated a number of times over the years whenever this subject came up , the canadian/ontario health system is NOT perfect , but i think it provides reasonable coverage for the vast majority of the citizens .

th greatest problem is a shortage of GP'S ... and there are several reasons for it :
- some years ago the government(ontario) of the day wanted to reduce taxes and decided cutting down on government funded health costs would be an easy way .
what they actually did was to restrict the admittance to medical schools and stopped issuing "billing privileges" , which meant that new physicians could not bill the ontario insurance plan for services rendered and in consequence could not treat patients (physicians and hospitals are forbidden by law to charge for government funded health services directly to patients) .

- since it takes some years (about 10 ?) to bring a new physician online , there is a shortage of doctors even though more med students are coming through the universities now .

- younger physicians usually like to have more of a family life than the old GP's had - they are simply not available around the clock anymore - and i can't really blame them .

- physicians with qualifications from a foreign country have a difficult time getting their credentials approved from the college of physicians and the government . a new program has just been introduced to guide these physicians through the accreditatin process - but my guess is , it will take some time (years ?) to have an impact .

- there a too few "nurse-practioners" in the canadian health system .
many/most physicians do all the medical work including bp checks , prescription renewals and other minor procedures .
an effort is underway to bring more "NP's" into the system .

those are some of the shortcomings of the canadian/ontario system .

on a personal level , we have don't have any major problems with the system . we have a good GP and can usually get an appointment on short notice - never longer than a day , often the same day .

we have a teaching(university) hospital in our city , so good hospital care is available locally .

since we have a additional private medical coverage (which quite a few , but not all citizens have) , most medications are paid for , 80 % of dental costs are re-imbursed . the monthly cost for this plan is appr $100 and also includes "out-of-country" medical insurance - which would be pretty expensive at our age through an individual plan .

so , to sum up :
while our total "health insurance" coverage is perhaps not a "platinum" plan - to borrow a term from the credit card terminology - , it is probably a gold plan .
certainly we are quite satisfied with it .
hbg

I think the shortage of GPs is happening everywhere, hamburger. I don't know if it's necessarilty because of universal health care. It's certainly happening where I live. There just isn't as much money in general practice. I suspect that's why.

What's a GP?

GP - general practitioner (I think)