Canada's Health Care System- Does it work for you?

[Liquid Blue]

Just saw this post on SA-

Here's the situation in Canada.

For certain procedures, there is in fact a 4-6 month waiting list. For instance, an older friend of mine had to get a double hip replacement. It took about seven months to get both of them done. On top of that, many things were not covered in the "recovery" process, such as physiotherapy.

On the other hand, I've had no problems with the GP section of Health Canada: I found a GP in about thirty seconds in downtown Toronto, and so far it's taken me a grand total of one week to schedule things like physicals and blood work and have them done.

The main problem with Health Canada is that we've had fiscal conservatives or moderates in power for the last thirty years trying to appear "responsible" like Brian Mulroney and Ronald Reagan. This means they've let doctor wages slip, and have completely ignored UHC in the hopes that people will see "the light" and support a two-tier "free market" system without the "government monopoly." Currently our doctors have very little incentive to stay in Canada, as there aren't any grants for newly-trained doctors to pay off their debt, so they just go south of the border or specialize in a "privatized" health sector.

Canada's UHC problem isn't a matter of wait times or lack of funding. It's because our politicians are too dimwitted to do anything except talk about the budget. The NDP, one of the stronger parties understands most of what I just said, i.e: offering incentive to doctors to stay in Canada, forgiving government student loan debt if they operate in Canada for x-number of years, etc. but they don't really have a shot at power at this point, and the Conservative governments' leader has consistently talked about how UHC is the devil and how people should be given a "choice", despite the fact that it would only further split the total staffing in Canada and completely annihilate UHC. Or maybe that's the point.

tl;dr: Canada's problem isn't funding. Our doctors have state of the art equipment and facilities. The problem is that there are no social policies to make the job easier for doctors, giving them very little incentive to stay in Canada. This is what creates the wait times: lack of manpower. If America has strong policies to help doctors then America's form of UHC won't have these problems.

For those that live in Canada, do you agree, disagree? Epi, from a doctor's perspective how is the morale, the incentive to stay in Canada for doctors?

I don't keep up with Canadian politics so I don't know how poorly (or admirably) your politicians are doing in regards to your Health Care system.

[Kolar]

Health Care hasn't been a political issue lately because when Paul Martin (then Prime Minister and leader of the Liberal Party) setup funding for something like 6 years for each province. Normally each province has to come back every year or so to get funding commitments from the Feds. The NDP (New Democratic Party) is gaining some support and I don't think their polices are anything radical or out of touch but they are unlikely to form a Government in the foreseeable future or even sit in as the official opposition. I don't know what the Conservatives would do in a majority situation, they did mess up Ontario really good a couple years back and a lot of those people are now part of the current Conservative Government at the federal level, but they are only able to form a Minority Government.

The guy who posted that is right about finding a doctor in Ontario, for urban areas it is very easy and I've never had a problem. Either that or I would goto a walk in clinic.

I don't think there is a quality issue with our health care system. I think there is a problem with wait times for special operations and conditions and all Governments in recent years (even the Conservatives) have tried to bring them down, and they have succeeded in some areas. The solution is to start putting money back into post-secondary, start freezing the tuition fees and carefully review and acknowledge credentials of newly immigrated doctors. As for keeping doctors here I don't know enough about that issue but we have to remain competitive.

[Jeenyuss]

i have two friends, both of which needed knee surgery. the older one, who needed it quite badly, waited for forever for it. the other one who's about my age waited only a couple months.

for someone who is usually into the doctor's office/hospital at least once a month i've never had any problems with the health care system. the one hiccup i had is that i had a lump right next to my scar tissue on my lower right abdomen. i'd continually go into my family doctor complaining about it. not that it was causing any pain or anything like that, just that it was there and it didn't seem right. i think i got two ultrasounds that wielded the results of 'probably just excess scar tissue'. about a year and a half-ish later it grew exponentially and started causing me a fair amount of pain. i was probably into the doctor/hospital every 5 days or so and it was a while before i got a ct scan finally. the ct scan showed that it was a fistula or whatever. ultimately they couldn't do anything or operate because it might've made the situation far worse than better, which is totally understandable. the only thing that pissed me off is that it took one and a half years to get to the bottom of it.

[Epinephrine]

Lots of things to address in this, so I should start from the top. First off, I'm not 100% sure how the American system works, but I think I have an idea so I will use what I think to compare and contrast, but correct me if I'm wrong.


Canada's health care system is run individually by each province. This means that each province has their own wait times strategies, each province pays doctors different amounts (you can make >1.5x more being a doctor in Alberta than being a doctor in Quebec for instance), and each province has their own policies on what they do and do not pay for. The federal government via the Health Canada Act gives out money to each province to help fund healthcare to the tune of what used to be 50% and is now increasingly less towards 25%. The basic idea is that, if the provinces want money from the Feds, they have to ensure that in the most basic sense, doctors cannot bill the public system while offering private services which are the same as covered services. As well, money must not be allowed to be used to allow patients to jump queues in the public system.

Because everyone is covered for free, there is virtually no benefit to being a private only doctor as you won't have any patients (and probably couldn't find any space in any hospital to 'rent' space anyway if you're a surgeon for instance). The only people who would go all the way private are doctors catering to corporations, and plastic surgeons. Things like laser eye surgery aren't covered by the government, so ophthalmologists can do this AND work in the public system at the same time without problems.

As each province has it's own programs, individually amongst provinces there are wide variations. Each province funds the majority of their system via their own taxes, and as such each province pays doctors different, and offers different services. For instance, in Ontario until a few years ago, eye exams were free, and now they are not free unless you're over 65 or have a serious medical condition that requires you to have frequent eye exams (glasses prescriptions do not count). Another example is that in Ontario, drugs are free for those over 65 and those who are on welfare and qualify for drug benefits via the Ontario drug benefit plan. As for wait times, Ontario recently put a billion dollars into lowering wait times for five major categories including hip surgery, cataracts and cancer treatment. This has been a pretty successful venture. Alberta in contrast put a lot of money into creating an electronic system so that patients can easily hook up with surgeons who had shorter waiting lists, and thus have reduced their lists quite well using that method.

Extra services may or may not be covered. Diagnostic services are covered, so any scan you need (x-ray, CT, MRI) is free, and so is laboratory based diagnostic services (blood, biopsies, etc). Physiotherapy is covered in Ontario, but basically it's being phased out by not giving any more licenses for the public system, and also very low payment rates, such that if you want to find a decent physiotherapist you must go private and pay top dollar. Dental work is not covered as well. Meanwhile some services like home care are covered.


In terms of actually hooking up with a specialist, Canada works in a system where family doctors are extremely important as the gatekeepers to the system. Family doctors are supposed to access all patients, and generally will do all the preemptive diagnostic investigating before they refer patients to specialists. The job of the specialist then is to either figure out very hard cases the family doctor cannot take care of, or to treat using more intensive methods than allowed at the family doctor's office (i.e. chemotherapy, surgery, heart stents, etc.).

In fact you basically cannot see a specialist without a referral. This is because specialists make 3x as much money in a first appointment if referred vs taking patients off the street. Now here's the tricky part. You cannot see a specialist without a referral, and family doctors pick whom to refer from. There is no centralized system for referrals (aside in Alberta), so family doctors will refer to specialists that they know. Rarely a patient will come in with a request about a specific person they want to see, which is fine as well as the family doctor will likely help them out.

The tricky part is that, because there's no way to see how long the waiting lists are of each doctor, referrals are just done 'blind'. Because of this, there can be WIDE variations in waiting times for patients. For instance, one surgeon might have limited hours and only operate once a week, while another might operate 4 times a week, and thus their waiting times will be different.

In the USA I understand one can just walk up to a specialist and demand to be treated and it works. The problem with such a system in my opinion is that specialist treatment is much more expensive, and patient demand doesn't always equate with real medical problem which can be fixed. For instance, I just saw a patient who got an expensive back surgery done from a neurosurgeon after being told that it would be pointless to do it in Canada. It cost this person $80,000 and in the end did nothing to cure the problem, but I'm sure the doctor in the US was laughing all the way to the bank.


A second part which affects waiting times is money. It costs money to run a hospital, money to run an operating room, money to hire and pay nurses (all unionized), and money to pay for enough hospital beds to house patients. Because the system does not have infinite money to spend, there are also limitations on how many people can be treated and how fast people can be seen. There is also somewhat of a doctor shortage in Canada at the moment which makes things worse.

So we reach the second part of the referral system at this point. Because they have limited time and resources, specialists will book patients by how urgent they deem a patient's problem to be. For instance, if you had a serious problem like cancer, you'd likely be seen right away. If you had a bad hip which was slowly progressing for years due to osteoarthritis, you might have to wait 6 months to get it replaced. There is no standard way to determine what illness is more 'severe', it's just up to the discretion of the specialist.

So in the end, the system works for sure for those with serious problems. No one is ever turned away from the ER, no one ever has to make a decision whether they can afford to be an in-patient or not, and inpatients who come in from the ER with anything serious are of course treated right away.

Patients who are referred who have anything serious are likewise seen right away.

It's people who have non-serious problems, which are more 'lifestyle' related that are put on the long waiting lists. Yes a torn ACL is going to suck if you're an athlete, but you're not going to die from it, nor will you be prohibited in doing normal things in your life, so you will have to wait. I think most people in Canada accept that there will be a wait for things, but accept that is the price to pay for having a free system where you never have to worry that if you have anything serious you would not be able to afford treatment for it.

And if you're wondering about level of care, we have the same machines, the same medications and the same methods of treatments in the US. In fact many Canadian doctors go to the same conferences as their American counterparts and vice versa. Furthermore, medicine is generally practiced to the same gold standard the world around, although there are variations between Europe and North America.

So the common misconception that you'd receive 'better' care in the USA is aside for some specific cutting edge work (i.e. experimental stuff where only 1 guy is doing it) is mostly a moot point. In fact in some select fields we're just as good if not better at experimental stuff than in the US.

As well, doctors will treat their patients using the same methods and the same high standards the world over (or else they will be negligent). Treatment regimens, diagnostic criteria, and specific drugs are basically the same in the USA and in Canada.

The biggest differences are that doctors in Canada have much less of an incentive to treat aggressive rather than conservatively because there isn't as large a financial gain from it. As well, we also do a lot less diagnostic tests, which has seen a huge explosion in the US as of late, which in the opinion of most doctors anywhere is pretty pointless anyway, but is a good money maker, and a good way to avoid liability in those one in a million cases where that MRI would have actually made a difference. In fact, the increase in scans like preemptive MRIs usually leads to finding a lot more subclinical diseases which are asymptomatic and probably don't ever need treatment but ends up leading to treatment which ends up costing a lot of money and time for patients and in the end helps no one but those making money off it.

[Epinephrine]

In terms of what's good and what's not for doctors themselves here, again it's provincial. As I said, different provinces pay different amounts. Until recently a lot of doctors were leaving Ontario because we paid so little (Quebec doctors are more stuck, especially if they only speak French). That tide has now more or less be stemmed due to the government actually giving us pay raises for the first time in decades. But to be sure, doctors were generally not leaving Ontario to go to the USA, but other parts of Canada. Leaving to go to the USA was very prevalent in the mid 1990s, but not so much in the last 10 years.

Also there has been a lot of reform of the system lately in Canada. For instance, doctors have been allowed to incorporate which means our taxes are significantly lower. There has been massive amounts of primary care reform, where family doctors are encouraged to and paid to work in teams rather than alone and provide 7 days/week after hours care. Because they are in teams and are not docked pay if one of their fellow partners sees their patients (paid 90% per patient per year and 10% per visit), they receive much more flexibility in schedules and are happier overall. I've read that this idea is slowly catching on in the USA, but with so many different insurance companies and vested interests, even if having doctors working in teams and being more happy is better for the system both in treatment for patient and in cost, the vested interests make this sort of change hard to implement.

As for leaving to the USA, the reasons are multifactorial. After the stress of dealing with HMOs (docs in the US can spend up to 1 hour a day dealing with insurance, here's it's very very easy to bill), people without insurance and being forced to see people for free if payments bounce (aka loss of income), and litigation expenses (our Ob/gyns pay like $5000/year in insurance vs >$100,000/year in the USA), doctors in the USA really don't make that much more money than Canada. Looking at publicly available stats and from what I have read, in fact doctors in Canada make only 10-15% less (or in other words make the same number amount but in Canadian dollars vs USD) and in some cases can make MORE money (Canadian ophthalmologists make like 3x as much as in the USA).

Secondly, where you live is largely a lifestyle issue. People who live in wealthy first world nations are not that likely to immigrate away without a really, really, really good reason to. I think Canadians actually prefer living in Canada vs living in the USA, and as such many don't move away because of that.

Thirdly there are political reasons. We're overall a lot more liberal here in Canada than in the USA, so in many ways going to the US would be more constricting to freedoms we're used to here in Canada. Canada is also overall much more multicultural, and seeing as how doctors are also an extremely multicultural bunch, moving to the USA aside from the ridiculously expensive cities of NYC, Boston or San Francisco does not sound that inviting because of the innate racism that is in many parts of the USA that isn't nearly as pronounced in Canada.

It is also easy to say, maybe it's only the bad doctors who can't leave who stay, but this is not just a symptom of the fact that maybe they aren't 'as good doctors' as American ones. I have worked with plenty of doctors who trained or did fellowships at Harvard, John Hopkins, University of Washington in St. Louis, or the Mayo Clinic, and they came right back to Canada. I've even worked with some (former) American doctors who moved up here.

Some last tidbits. In my class of 100, only 1 person went to the US to do residency. I have also very, very rarely worked with any medical student or resident who has seriously considered moving to the USA to be a doctor.


So in conclusion, when you factor in money, living conditions, family, and so on, there just isn't that big a reason to go to the USA anymore.The fact is, being a doctor in America isn't that much better or in many cases even worse off, so the vast majority of doctors now choose to stay here.

[Liquid Blue]

Oh I didn't mean only go from Canada to the US, I was simply wondering if alot of doctors in your area/that you know had considered leaving Canada period to find better work/ conditions elsewhere, worldwide.

Great amount of info I'm learning here though, thanks everyone and keep it up~

[Epinephrine]

Working worldwide as a physician is extremely hard. This is because each country has their own systems in certifying doctors, and each country will have different names for drugs, and of course patients will speak different languages. Medicine is about patient care first and foremost and unless you can communicate fluently with your patients, then no matter how smart you are, you might not get the right diagnosis or offer the correct treatment according to the patient's needs.

There are lots of doctors in Canada who may spend a year or two working in Australia or New Zealand for fun but then return back to Canada. As for going to the UK, that's generally harder as we're not EU citizens.

(ps added a bit more to the end of my first post just now, be sure to read it :P)

[project dragon]

As for wait times, Ontario recently put a billion dollars into lowering wait times for five major categories including hip surgery, cataracts and cancer treatment. This has been a pretty successful venture.

Recently, my father got diagnosed with a form of head-and-neck cancer. He was diagnosed mid-February, and treatment began early March. Thank-you Ontario government!

(Last month, they said his treatments worked well, and is now cancer-free)

ps. out of curiosity, where do you work Epi?

[Nycle]

There are lots of doctors in Canada who may spend a year or two working in Australia or New Zealand for fun but then return back to Canada. As for going to the UK, that's generally harder as we're not EU citizens.

They're working on that. Britain is expected to have the largest population within the EU in a few decades. But since this growth is mostly fueled by relatively unskilled immigrants, I reckon that especially there they would more than welcome highly skilled workers.

Canada is a nice place though, visited it a few times and I wouldn't see any reason to leave other than a raise.

[castromarx]

Canada is a nice place though, visited it a few times and I wouldn't see any reason to leave other than a raise.

How about 8 months of winter?

[Squeezer]

I just realized, probably because I'm really baked for the first time in a long time, that there are a lot of very good, inquisitive writers on these boards.

it's fun to read.

Make a newspaper for profit?

[paradise!]

All everyday doctor visits are taken care of very easily. Unless you are getting surgery/hip replacement, everything else is truly great. I have seen few really packed ER waiting rooms.

[Epinephrine]

Recently, my father got diagnosed with a form of head-and-neck cancer. He was diagnosed mid-February, and treatment began early March. Thank-you Ontario government!

(Last month, they said his treatments worked well, and is now cancer-free)

ps. out of curiosity, where do you work Epi?

North York General.

[Adman]

North York General.

I know that place, my uncle went there for a sore foot and they took out his kidney!

haha

[Krusnik]

This isn't going to be as impressive as epi's post but I've been having to deal with health care a lot over the last few years so I'm hoping this helps. Nobody will probably read it but meh.

In 1998 I, being the dumbass 8 year old, swallowed a battery. Yes, a battery. It was one of the flat round battery's you would find in watch. Anyways, the thing got stuck in my throat, and I ended up going to the hospital. The hospital I find (in those days) was a lot better than it is now, and they called in a surgeon from North Vancouver who was able to get the battery out. All of this happened in the span of about 3 hours (in the middle of the night on Christmas eve). After this point in my opinion at least the hospital (BC Children's Hospital) started declining in the quality of care it could provide (it is understaffed).

-

Shortly afterwards, I started having certain problems: my skin was pale, shortness of breath, lost my appetite, and some more I can't remember. I visited two physicians who could not figure it out. The first family doctor told me it was an allergic reaction, and the second one told me I was eating too many carrots (wtf?).

In April my parents chose to take me out of school for a week to see if I would recover any faster.. During the course of the week I ended up having an attack. I call it an attack, because I still don't know that it is called. Basically my fingers and toes curled up, my mouth seemed to moved leftwards, and I couldn't walk anymore. A few hours later at the hospital, we found out that I had developed Leukemia (ALL).

Almost every person who I've talked to who has had cancer of some sort, has a similar story to tell. There is a general feeling around here, that doctors can not be trusted upon. Even with a second or third opinion we weren't able to get to the root of our problems.

--

I had Leaukemia for a total of five years (3 years when diagnosed + 2 years for relapsing). I had leaukemia in my bone marrow, and later when I relapsed in one of my testicles (one of them, they treated it with radiation so I still have my boys). Throughout the years I spent time in several wards, and spent a lot of time in emergency. I can never stress this enough, but the hospitals in Vancouver are really understaffed. Many of the nurses in the wards that I went to were always overworked. Having to deal with sick/grumpy kids, who sometimes even have angry parents is a tough thing to do and many of the nurses have told me that even having an extra person around would help a lot. There was also a lack of space, the ward I usually went to always reshuffled the beds constantly to make space. I have seen kids waiting in the hallways just for a bed to free up, and it is not fun. (Sometimes kids have to be put into isolation, and it really screws things up since a lot of the rooms had more than one bed). You can take everything I've said about the wards, and apply them to the clinics (oncology/hematology in my case).

In 1999 if you needed a simple surgery the wait times weren't too long, I use to have a VAD (its a port for IV's n whatnot). They would poke at the port instead of poking the kid on the hand (they would have to hold me down each time). Before my relapse the wait time for the surgery was about two weeks, and the same applied for getting it removed. I could see how putting it in would have been a priority, but removing it wasn't and in those days it was really fast. Fast forwards a few years to 2004, when I needed it removed. It took a year to get the port out, I understand having to wait, but waiting a year is much too long. I just wanted to be over and done with that part of my life.

--

Outside of chemotherapy I found my experience to be really good. I have always had access to psychiatrists, endocrinologists, physiologists, social workers etc. There is a lot of support from the community for both kids and parents. Camp Goodtimes, Make a Wish Foundation, Dreams take Flight, are just a few of the organizations that really helps those who need it (and they do a wonderful job). For some pills, such as Ondansatron you had to pay $20 per pill, but if you did not have the money to pay for it the social workers are always able to help you out somehow. Today I see a specialist every 6 months, an oncologist every 3 months, and my family doctor every month. The appointments are always on time, fast, and rarely are there ever any hiccups.

The system through my eyes does have its weaknesses, but it also has its strengths. The good thing is people, in BC at least, have started to realize that. There are hiccups here and there, but overall I'm alive today aren't I? I love our health care system, and I definitely would not want to see it become two-tiered. Ever. It worked for me, and it still does. We just need more personnel, and space.