For our Canadian Friends. . . .your healthcare system?

[Laura Corin]

I thought this thread was meant to be politely asking Canadians about their healthcare system.  Wasn't that what the OP wanted?  I was enjoying hearing the stories of how it has actually worked for our respected fellow board members.  Not having to wade through the same old US healthcare swamp.  Oh well.

 

L

[Dory]

If by free you mean you don't have a copay and you don't get a bill for your portion, then yes it is.  But someone IS paying for it.  The taxpayers.

 

We had income tax, sales tax, and property tax before they made our healthcare here 'free' so, yes, the taxes do pay for healthcare I suppose, but since they didn't change to cover the healthcare, and the healthcare premiums are no longer existent, it is basically free. I am not paying for them anymore. I had to pay those other taxes anyway. My property taxes are about the same as my friends in Manitoba, we don't have a provincial sales tax and our GST is the same as every other province. I call that free.

[SproutMamaK]

In my province (Ontario), we have one additional health service that's a big positive for me,called Telehealth Ontario. Basically, it's a 24 hour hotline staffed by nurses that you can call and ask questions. It's been handy for us several times when we're not quite sure what to do and don't want to waste two hours the next day shuffling back and forth to the doctor for something that may not even need attention. EG, my child drank X amount of Y substance, what should I do?  How can I tell if these itchy bumps are insect bites or an allergic reaction?  My son hit his head and I THINK he's okay but what do I need to watch out for, etc etc. It's been a great resource for us. It's like a step between looking stuff up and the internet and running to the ER with something that's just not a big deal, lol.

[Mom0012]

Also: less helicopter parenting around the possibility that little Johnny could get hurt.

 

Yeah, no one wants their kid hurt -- but people who stand to pay a (maybe?) couple of thousand dollars for a broken arm might be a little more fearful than those of us who can easily get little Johnny patched up at the hospital and carry on with summer vacation only impeded by a cast.

Really? I don't want my child hurt period. I'm not a helicopter parent, but whether the health care was already paid for through taxes or not would have zero impact on how I would monitor my kids. I have never thought, oh, I'd better stop ds from doing _______ or I'm going to get a large medical bill. I also don't know anyone who has ever sued someone over an injury.

 

I also have to wonder about the Canadian poster who used to be here a lot and had the horrible nerve trouble with her arm. I can't remember her name, but I do remember her frustration not only with the arm, but with simply getting care for a pregnancy she was well into after a move.

 

The comments about not being able to decide which doctors you will see and having to wait are deal breakers for me. I have to wonder what type of health issues people have had who are happy with that type of care. Sure, it's great for a broken arm, but what if you have more ambiguous health problems like Lyme? My family has experienced a myriad of health issues that have been difficult to find the right treatment for even here. I can't imagine having to get permission from a doctor to see another doctor, but I guess I have very little faith in the medical profession anyway.

 

Are you able to pay out of your own pocket to see another doctor if you have an urgent healthcare need that your system does not feel is urgent or does not recognize?

[QueenCat]

Cancer was 99.5% covered pre Obama care in the typical employer plans in this area, the 0.5% being the co-pays for the physician visits and the co-pays for the prescriptions. People didn't pay oop for imaging or bloodwork or chemo or radiation.

 

Now, with Obamacare, the person pays coinsurance on everything (bloodwork, diagnostic imaging, chemo, radiation, physical therapy, etc) after meeting the deductible until the out of pocket max is reached. Prescription costs and co-pays are not included in the oop calculations. Some plans include the deductible in the oop calc, some don't.

 

So, a person with cancer now pays their premium, which is significantly more than before Obamacare, then in addition to the preObamacare plan, also pays the high individual deductible (I'm hearing numbers ranging from $1000 - $5000 for people who are employed by large profitable corporations).    Folks here with extensive needs are finding that for the first time in their life, they can qualify for the IRS medical deduction, because of the high deductibles these new plans have. And they are just amazed that they are supposed to be happy that things like birth control are 100% covered..forget that, go back to the past and again cover the bloodwork and the imaging 100%.

 

Also, a heads up from older ladies:  your post-breast cancer mammo is not covered 100%, as it was before Obamacare. With the new codes, mammos are now either screening or diagnostic. Those that have had breast cancer will be coded diagnostic, even if a masectomy was done and the remaining breast was cancer free at time of masectomy.  Pricing that (and any follow up ultrasound), depending our your deductible and your age , you may find it significantly cheaper in the short term to go the Angelina Jolie route.

 

All of the above, in reference to what people paid before, is truly dependent on their specific plan. And my insurance does pay for post-cancer mammograms at 100%. That is now, not in the past. Our deductible includes cancer treatments. They were never covered at 100% before the deductible had been reached. Not in the past, not now, not next year. All of it is dependent on the exact plan.

[QueenCat]

In my province (Ontario), we have one additional health service that's a big positive for me,called Telehealth Ontario. Basically, it's a 24 hour hotline staffed by nurses that you can call and ask questions. It's been handy for us several times when we're not quite sure what to do and don't want to waste two hours the next day shuffling back and forth to the doctor for something that may not even need attention. EG, my child drank X amount of Y substance, what should I do?  How can I tell if these itchy bumps are insect bites or an allergic reaction?  My son hit his head and I THINK he's okay but what do I need to watch out for, etc etc. It's been a great resource for us. It's like a step between looking stuff up and the internet and running to the ER with something that's just not a big deal, lol.

 

Our insurance company provides this service... here in the U.S.

 

[SKL]

What the emergency room here does is give the patient the info on where to find his med at low cost. Many people don't read informational signs and don't know that they can get their metformin for free at the local grocery store, for ex.

 

Yes, I've had that happen as well.  They will tell you that x pharmacy will take my insurance for generic drug A and B, but y grocery store will give me drug C for free.

 

And my HMO has a health line I can call any time as well (at no individual cost).  I'm sure it saves them money.  ;)

[emzhengjiu]

I thought this thread was meant to be politely asking Canadians about their healthcare system.  Wasn't that what the OP wanted?  I was enjoying hearing the stories of how it has actually worked for our respected fellow board members.  Not having to wade through the same old US healthcare swamp.  Oh well.

 

L

I am interested in a reasoned discussion of different health care systems!  But I found myself responding about our situation in the U.S in this tread.  It's so frustrating to me when people discount the issues with health care here.  No matter how many people tell me what a wonderful system we have, I know that for me and for many people I know in real life, it just isn't so.  

[QueenCat]

  I called a major cancer center in NYC on behalf of a friend; they explained clearly that it is the law that post-cancer mammos are coded diagnostic. So, glad to know that there are plans that are offering diagnostic imaging at 100%...or does your plan restrict that to just the diagnostic mammo?

 

They cover all diagnostic imaging at 100% once the deductible has been reached. Actually, almost everything is covered at 100% once the deductible has been reached. One of dh's co-workers looked into the mammo specifically, for next year, because his wife has to have them done ever 3 months right now. I didn't think they'd have an issue since the wording in the policy book is the same for 2014 as it is for 2013 so I wasn't surprised.........

[QueenCat]

I am interested in a reasoned discussion of different health care systems!  But I found myself responding about our situation in the U.S in this tread.  It's so frustrating to me when people discount the issues with health care here.  No matter how many people tell me what a wonderful system we have, I know that for me and for many people I know in real life, it just isn't so.  

 

I know what you mean. My family is fortunate to have excellent insurance, for the past 4-5 year. Before that, we paid so much more, and at one point had some serious medical debt.

[wintermom]

We had income tax, sales tax, and property tax before they made our healthcare here 'free' so, yes, the taxes do pay for healthcare I suppose, but since they didn't change to cover the healthcare, and the healthcare premiums are no longer existent, it is basically free. I am not paying for them anymore. I had to pay those other taxes anyway. My property taxes are about the same as my friends in Manitoba, we don't have a provincial sales tax and our GST is the same as every other province. I call that free.

 

No, it's not free. Who do you think is paying the salaries for the doctors, nurses, etc.? It's all coming out of our taxes one way or another. You may not see the individual charges anymore, but they are there.

 

Health care is organized by the various provinces, and each province has handled things a little differently. Alberta used to have separate health care premiums, where OHIP isn't separated out in Ontario, though there was talk of extra taxes being collected specifically for health care. It does not mean that the money isn't being paid in anymore.

 

Don't forget that Alberta is a "have" province. Pretty soon you'll be paying every province's health care! (Just a very bad, very sad, joke)

[4everHis]

In my province (Ontario), we have one additional health service that's a big positive for me,called Telehealth Ontario. Basically, it's a 24 hour hotline staffed by nurses that you can call and ask questions. It's been handy for us several times when we're not quite sure what to do and don't want to waste two hours the next day shuffling back and forth to the doctor for something that may not even need attention. EG, my child drank X amount of Y substance, what should I do?  How can I tell if these itchy bumps are insect bites or an allergic reaction?  My son hit his head and I THINK he's okay but what do I need to watch out for, etc etc. It's been a great resource for us. It's like a step between looking stuff up and the internet and running to the ER with something that's just not a big deal, lol.

We are fortunate enough to have a nurse at our Dr.'s office that we can call for things like this. Makes making decisions so much easier and less stressful. Am I right in assuming you are from Canada? Is this the norm for Canadian healthcare?

[4everHis]

If you would like to discuss healthcare outside of Canadian healthcare maybe you could start a spinoff thread? I appreciate all input but the original question was about Canadians and their thoughts on their system. That conversation is getting lost in the discussion about USA healthcare.

 

Please take this request in the tone in which I type, pleasant and gracious. :)

[KarenNC]

How is physician education funded in Canada? I wonder if that plays into this at all.

[swellmomma]

In my province (Ontario), we have one additional health service that's a big positive for me,called Telehealth Ontario. Basically, it's a 24 hour hotline staffed by nurses that you can call and ask questions. It's been handy for us several times when we're not quite sure what to do and don't want to waste two hours the next day shuffling back and forth to the doctor for something that may not even need attention. EG, my child drank X amount of Y substance, what should I do?  How can I tell if these itchy bumps are insect bites or an allergic reaction?  My son hit his head and I THINK he's okay but what do I need to watch out for, etc etc. It's been a great resource for us. It's like a step between looking stuff up and the internet and running to the ER with something that's just not a big deal, lol.

 

We have this in Alberta too, it is called Health link.  I have the number memorized and use it often.  Perfect to call up and ask, hey child has x going on, is it better to give tylenol or motrin.  Or hey, I did this to myself, is it something that can wait until office hours tomorrow or is it really something that should be seen asap at the ER.  Etc, yup, I love health link.  Those nurses know their stuff, go through triage with you over the phone and advise you whether you need immediate medical attention, call your dr the next day attention, or wait and see approach.

[swellmomma]

How is physician education funded in Canada? I wonder if that plays into this at all.

 

As in med school? they pay for it themselves just like any other degree.  If they qualify for student loans they get them and pay them off when they start working.  For continueing education again they pay for it themselves to keep current on things.  I used to work in a peds office, he would attend conferences etc that gave him x number hours towards the minimum he had to do in continueing ed each year to keep his license and paid for them all himself.  Also drug rep companies would come in and provide lunch and discuss what ever med they were peddling, but beyond an invitation to attend a conference for free they could not offer anything else.  Dr's can not accept bonuses from drug companies to push that particular drug. I have heard differently about the states.  And while the meals were good they weren't anything over the top (swiss chalet, a sandwich tray from a catering place, take out from various international food places-korean, chinese, greek etc). 

[bolt.]

How is physician education funded in Canada? I wonder if that plays into this at all.

Students pay tuition for pre-med and med school either by scholarships, through student loans, or through savings (theirs or their parents, or whatever).

[bolt.]

PS: I love the Healthlink line!

[livetoread]

How is physician education funded in Canada? I wonder if that plays into this at all.

A quick search says that it costs over 250k to educate a doc in the US, and less than 50k in Canada. So it's over 5x as much in the US.

 

I used to drive myself crazy asking why they charge x, y, and z when it comes to healthcare here in the US. I've finally decided that, while the complete answer is complicated, the biggest reason is because they can.

[QueenCat]

See, that's my point. The typical employer plan pre-AHA, in this area, covered diagnostic imaging 100%, without needing to meet the deductible first.  Now the deductible has to be met first (thats $1000-5000 ), and then cost sharing kicks in until the out of pocket max is met (5000 up). Older women are paying a lot of money in premium plus deductible and o-o-p in return for a mammo, some bloodwork, and an annual...more than if they dropped the plan and paid solely out of pocket.  Good plans if something catastrophic happens, but very expensive if its a typical healthy year.

 

----------------------------------------------

 

 

I find the compare and contrast between different countries health systems to be helpful.  I grew up with military medicine, never saw the same doctor twice. I like civilian medicine with a relationship with the primary.

 

We've always had to meet the deductibles first. That's not a recent change for us. The only things that didn't apply to the deductible were certain preventive care measures (things like well child checks, annual physicals for adults, vaccines). I can tell you with the AHA, they are required to cover the annual exam at 100%, no application of the deductible or any co-pays for that service. That part of the law is already in effect. There are so many different employers around here that I have no idea how they approached diagnostic imaging in their various plans (there is quite a variety of local, regional and national companies, as well as a lot of defense contractors).......... Generally, I only know something like that if someone is complaining about it........ although people have been talking lately about costs not being as bad as they thought they would be, when discussing premiums/deductibles for next year.

 

[KarenNC]

I find the compare and contrast between different countries health systems to be helpful.  I grew up with military medicine, never saw the same doctor twice. I like civilian medicine with a relationship with the primary.

 

So, would Canadians say it is typical that you can maintain a long-term relationship with your primary physician unless you move (or the doctor moves or retires)? Are group practices common, and, if so, can you request a particular doctor in the practice when setting up an appointment (realizing that emergency care is a different situation altogether). Since there's been mention of going outside one's local area to a more preferred hospital or provider,  Is there an issue with your primary doctor not having admitting privileges or being affiliated with a hospital or service that's further away?

 

[Embassy]

I am a US citizen living in Canada.  I have had many different insurance plans in the USA.  Aside from the cost, the biggest differences I have found is that doctor's offices aren't quite so plush in Canada.  They don't have all the comfy features found at many US offices.   Hospital rooms aren't quite as nice either.  You even have to rent a TV.  But quality of care has been excellent.  My doctor is very thorough.  It can be a little difficult to find a doctor accepting new patients though.  It isn't difficult to get in to see a doctor, but if you want your own doctor you may have some difficulty finding one.  

 

I love the free eye exams for kids!  Dental isn't free, but I did have one visit where I was only charged $20.  That was the total cost too!

 

I've heard many complaints from Canadians about their healthcare.  I think there is always room for improvement, but I don't think Canadians typically understand how many families in the USA have to choose between groceries and going to the doctor.

[Dory]

Really? I don't want my child hurt period. I'm not a helicopter parent, but whether the health care was already paid for through taxes or not would have zero impact on how I would monitor my kids. I have never thought, oh, I'd better stop ds from doing _______ or I'm going to get a large medical bill. I also don't know anyone who has ever sued someone over an injury.

 

I also have to wonder about the Canadian poster who used to be here a lot and had the horrible nerve trouble with her arm. I can't remember her name, but I do remember her frustration not only with the arm, but with simply getting care for a pregnancy she was well into after a move.

 

The comments about not being able to decide which doctors you will see and having to wait are deal breakers for me. I have to wonder what type of health issues people have had who are happy with that type of care. Sure, it's great for a broken arm, but what if you have more ambiguous health problems like Lyme? My family has experienced a myriad of health issues that have been difficult to find the right treatment for even here. I can't imagine having to get permission from a doctor to see another doctor, but I guess I have very little faith in the medical profession anyway.

 

Are you able to pay out of your own pocket to see another doctor if you have an urgent healthcare need that your system does not feel is urgent or does not recognize?

 

I'm still sorting through the comments on here trying to find the one that says you can't choose what doctor you see. I've never come across that. Even with getting a referral to a specialist, I can request which one I want to see and my family doctor will send the referral to that person. I chose my family doctor, and twice when his wait times were getting too long to get in to see him, I just went to a different doctor for that time. It's never been a problem. I have a good relationship with my doctor, and if I really need to get in to see the specialist quickly, he'll often send an extra note and bump me up the list a little quicker. With mental health, my doctor talked to me thoroughly about what psychologists and psychiatrist were available out there and the pros and cons of each before sending a referral to one. It really saved me a lot of headache of having to check each one out.

[Coffeetime]

If by free you mean you don't have a copay and you don't get a bill for your portion, then yes it is.  But someone IS paying for it.  The taxpayers.

Yes, but here in the US we pay our taxes, AND our monthly insurance premiums, AND our deductibles, AND whatever percentage of treatment isn't covered by insurance, AND for procedures that are not covered by insurance… I would venture to guess that after adding all of that up we are paying much more in the US for far less coverage. 

 

This is a really interesting thread. Loving all the info. Makes me want to move the 300 or so miles up to Canada, frankly. ;)

[liber]

We had income tax, sales tax, and property tax before they made our healthcare here 'free' so, yes, the taxes do pay for healthcare I suppose, but since they didn't change to cover the healthcare, and the healthcare premiums are no longer existent, it is basically free. I am not paying for them anymore. I had to pay those other taxes anyway. My property taxes are about the same as my friends in Manitoba, we don't have a provincial sales tax and our GST is the same as every other province. I call that free.

 

Umm,  I think your definition of free and mine is different.  Property taxes don't pay for healthcare but your provincial and federal taxes do.  So unless you don't pay taxes then I guess it is free for you  because someone else  is paying for you.

 

 

Contribution from General

Revenue Fund

83.8%

 

Transfers from Government

of Canada

 14 9%

 

 

Those stats are for Alberta.

 

 

Basically our system is a glorified group insurance plan that treats everyone equally, equally bad.  It is a inefficient system that needs an over hull.  It doesn't have to be like the US system.  Although that is why Canadians don't want it changed because the proponents of the current system scare people into thinking that is what we will get if the system is changed.  I think Singapore has a pretty decent setup.

 

Not to offend you, but your attitude of it's free really galls me.  I think it shows a complete lack of ignorance of how the system actually works and how expensive it is to maintain.  I know a lot of Canadians feel like you do and I think that attitude fosters an entitlement attitude, not saying that you have one, but it makes it hard to have a real conversation about how ineffective and inefficient our system can be.  Comparing our system to the American system as if it is somehow better, I think is intellectual dishonest and it doesn't allow us to real conversations about what alternatives are out there.

[bolt.]

So, would Canadians say it is typical that you can maintain a long-term relationship with your primary physician unless you move (or the doctor moves or retires)?

 

>> Yes, it's typical to not change doctors unless you "need to" for a practical reason.

 

Are group practices common, and, if so, can you request a particular doctor in the practice when setting up an appointment (realizing that emergency care is a different situation altogether).

 

>> Shared office space is common. You still make your appointments with your doctor. Another doctor at the same office might be an option, say, during your Dr's vacation or something.

 

Since there's been mention of going outside one's local area to a more preferred hospital or provider, Is there an issue with your primary doctor not having admitting privileges or being affiliated with a hospital or service that's further away?

 

>> I don't know what "admitting privileges" are. Generally in-hospital care is done by a hospital-based doctor, and your main doctor would do non-hospital care. Your doctor can "refer" you to a hospital doctor or a hospital department... Is that what you mean?

 

[NoPlaceLikeHome]

Maintenance meds have been separated out on some of the plans offered to us next year thru the employer in the US.  For me, my  maintenance med was already on the local pharmacy's low cost plan so it's not a huge cost saving to have it 100% covered.

 

I'd rather have a low deductible than a less than $10 a month savings on meds.

 

 

 

What the emergency room here does is give the patient the info on where to find his med at low cost. Many people don't read informational signs and don't know that they can get their metformin for free at the local grocery store, for ex.

 

---------------------------------------------

 

 

 

I don't need a Telehealth line. My dr will call back if it is something the Nurse can't tell me over the phone. He'll also call in a prescription. That's one of the benefits of having a long term relationship.

I recommend the article I posted earlier. I am a nurse and many maintenance meds for chronic conditions are very expensive and there are no generic alternatives at all such as asthma. Or sometimes the generics do not work or stop working for particular patients such as me. I tried many different blood pressure meds including many generics and finally had to try one that was not available as generic which cost out of pocket $250.00 per month without insurance. Out of pocket medications for asthma can easily cost up to $1000.00 per month without insurance. So I am not talking saving a measly $10 per month.

[Dory]

 

Umm,  I think your definition of free and mine is different.  Property taxes don't pay for healthcare but your provincial and federal taxes do.  So unless you don't pay taxes then I guess it is free for you  because someone else  is paying for you.

 

 

Contribution from General

Revenue Fund

83.8%

 

Transfers from Government

of Canada

 14 9%

 

 

Those stats are for Alberta.

 

 

Basically our system is a glorified group insurance plan that treats everyone equally, equally bad.  It is a inefficient system that needs an over hull.  It doesn't have to be like the US system.  Although that is why Canadians don't want it changed because the proponents of the current system scare people into thinking that is what we will get if the system is changed.  I think Singapore has a pretty decent setup.

 

Not to offend you, but your attitude of it's free really galls me.  I think it shows a complete lack of ignorance of how the system actually works and how expensive it is to maintain.  I know a lot of Canadians feel like you do and I think that attitude fosters an entitlement attitude, not saying that you have one, but it makes it hard to have a real conversation about how ineffective and inefficient our system can be.  Comparing our system to the American system as if it is somehow better, I think is intellectual dishonest and it doesn't allow us to real conversations about what alternatives are out there.

 

 

Well if those taxes weren't paying for healthcare, they would just come up with something else that they needed to pay for. Those taxes didn't change any when they took away our paying health premiums in this province. I'm not saying that we don't pay for healthcare, I'm not completely ignorant on where our tax money goes, I'm just saying that this is as close to free as it really gets. Everything has to be paid for somehow, no matter how "free" it seems. Healthcare is no different.

I was actually thinking of the difference between Alberta and the other provinces, not so much just Canada and the US.

Our system is inefficient in many ways, but I still am relatively happy with it. That being said, I realize I'm simply happy with it because of where I live. If I were to live somewhere else, I wouldn't be very satisfied. That shouldn't be, it shouldn't whether someone lives in the country or a city.

I don't really care that my 'attitude' galls you. It's slightly insulting to be called ignorant, but that's your opinion I suppose. I don't feel entitled to anything, I work for everything I have and I firmly believe that there is no such thing as 'free' things in this life. But this is about as free as this sort of thing gets. Unless I'm completely missing something. I think anyone arguing over it's cost has more of a problem with entitlement than I do. After all, I don't expect it to be any more 'free' than this. Those arguing it sound angry and frustrated that it isn't more 'free'.

 

 

Just to add on here, after thinking about this a bit, I think a sense of entitlement is appropriate. After all, I put into the country, I should get something out of the country. I am entitled to good healthcare. I can't think of why I shouldn't feel entitled to it. I pay my taxes, I work hard, I am entitled to education and healthcare, because that's what the province and country promised me for my contribution. And neither of those are being given appropriately and to the amount that they have been promised.

 

[AimeeM]

Most doctors here (in the US) have hospital privs - they can come into the hospital and treat their own long term patients. When I had my c-sections, the private practice OB I saw off campus came in to do my surgery (into the hospital); he needed hospital privs to do so.

When my son saw a private practics pulmonary team, that team had the right to come into the hospital and oversee my son's treatment.

 

So, would Canadians say it is typical that you can maintain a long-term relationship with your primary physician unless you move (or the doctor moves or retires)?

>> Yes, it's typical to not change doctors unless you "need to" for a practical reason.

Are group practices common, and, if so, can you request a particular doctor in the practice when setting up an appointment (realizing that emergency care is a different situation altogether).

>> Shared office space is common. You still make your appointments with your doctor. Another doctor at the same office might be an option, say, during your Dr's vacation or something.

Since there's been mention of going outside one's local area to a more preferred hospital or provider, Is there an issue with your primary doctor not having admitting privileges or being affiliated with a hospital or service that's further away?

>> I don't know what "admitting privileges" are. Generally in-hospital care is done by a hospital-based doctor, and your main doctor would do non-hospital care. Your doctor can "refer" you to a hospital doctor or a hospital department... Is that what you mean?

 

 

[bolt.]

Yes, OB's have "offices" for seeing patients and also attend their own patients in hospitals (or share that duty with other OB's on a mutually agreed and fully disosed rotation).

 

I wouldn't expect a family doc to do much of the treatment if a hospitalized patient. It think They would probably be treated by a specialist is whatever they were being hospitalized regarding. I could be wrong about that. There would definitely be consultation.

[KarenNC]

>> I don't know what "admitting privileges" are. Generally in-hospital care is done by a hospital-based doctor, and your main doctor would do non-hospital care. Your doctor can "refer" you to a hospital doctor or a hospital department... Is that what you mean?

 

Not quite. Here, my doctor would have "admitting privileges" with a particular hospital or group of hospitals, which means if I need surgery or inpatient care or a test that needs to be done at the hospital, that's the hospital I have to go to, because my doctor is considered part of that hospital's staff. I think there are some hospitals that have "hospital doctors" or hospitalists, but not all. I've only relatively recently begun to hear the term. My doctor will make rounds in the hospital to see her patients who are there as well as see them in her office. The hospital does have separate ER doctors.

 

For instance, we have two hospital systems in our area (A and B). Each one has specific doctors and specialists associated with it. System A is part of my insurance network, system B is not. My doctor can admit patients, deliver babies, etc in system A hospitals, but not system B. I can only go to hospitals, therapists, and other providers associated with system A if I want my insurance to cover it, even if I live next door to a system B hospital or provider. In an extreme emergency (like a heart attack or severe trauma), when it was not possible to get to a system A hospital, the insurance would probably cover emergency service at the system B hospital, but at a much higher out of pocket cost.

 

It's actually gotten simpler here over the years as system A has been buying up many of the smaller hospitals in the metropolitan area.  We did have the issue of having to switch doctors and hospitals from B to A when my husband's company switched insurers one year. This was a few months before my daughter was born, so I was allowed to continue to see my OB through my initial postpartum visit and to deliver at hospital B only because I was far enough along in my pregnancy not to be required to switch immediately. I was glad because I preferred the maternity services at hospital B (and it was closer to my home).

 

As to the group practice, at the pediatrician, there are several doctors, so we can see whichever one has an opening if we want to be seen quickly, but can request a certain doctor and wait. At my OB, I was required to see a rotation of all the doctors throughout my prenatal care, as there was no guarantee which one would be on call when I delivered.

[Sarah CB]

Really? I don't want my child hurt period. I'm not a helicopter parent, but whether the health care was already paid for through taxes or not would have zero impact on how I would monitor my kids. I have never thought, oh, I'd better stop ds from doing _______ or I'm going to get a large medical bill. I also don't know anyone who has ever sued someone over an injury.

 

I also have to wonder about the Canadian poster who used to be here a lot and had the horrible nerve trouble with her arm. I can't remember her name, but I do remember her frustration not only with the arm, but with simply getting care for a pregnancy she was well into after a move.

 

The comments about not being able to decide which doctors you will see and having to wait are deal breakers for me. I have to wonder what type of health issues people have had who are happy with that type of care. Sure, it's great for a broken arm, but what if you have more ambiguous health problems like Lyme? My family has experienced a myriad of health issues that have been difficult to find the right treatment for even here. I can't imagine having to get permission from a doctor to see another doctor, but I guess I have very little faith in the medical profession anyway.

 

Are you able to pay out of your own pocket to see another doctor if you have an urgent healthcare need that your system does not feel is urgent or does not recognize?

 

I don't know who doesn't get to choose their own doctor.  We've always picked our own doctors and had the ability to choose our own specialists as well.  If we want to see someone outside of office hours we can go to any clinic we'd like or, in an emergency, the ER.  I've had issues in pregnancy and always saw an OB right away.  I had midwives (that I didn't have to pay for) as well as an OB for my second pregnancy - hospitalizations, etc.  All no problem.  We've seen a number of specialists with the kids and haven't had an extraordinary wait - even though none of their problems were what I considered urgent.  

 

My mom had what she thought was a cardiac problem and she was able to get into a cardiac clinic asap and do a ton of testing without any waits.  Meanwhile, my mil felt her wait for an MRI was too long, so she went to a private clinic and paid for it herself.  

 

We've always felt very taken care of here.  We love our doctor and have had positive experiences in the hospital.  I love that I don't ever have to consider whether something is "covered" or not.  We get the care we need to without worrying about the cost.

[swellmomma]

Well I typed up a long reply and then got a 504 error message.  Long story short I had the same GP for 34 years, my mom started seeing him when she was pg with me, he delivered me and continued to be my dr right through 3 of my pregnancies though by then he no longer did delivers.  He retired a couple years ago now.  He was in a large clinic and each dr took a turn as dr on call each day so I could just walk in to be seen if I could not get an appt with him as quickly as I liked.  The kids ped is in an office with 2 other dr's, they see their own patients, no swapping of drs generally, they just share the space and overhead costs.

As for hospital privileges, my old GP only had them at the hospital in the city he worked in, if I needed to be seen in a larger one in the bigger city I just saw whomever was on call when my referral was put in or when I got there kwim

[briansmama]

Now I want to move to Canada. I just learned that students in Canada are outperforming American students, including those in affluent US schools. Why can't the US get it together?

[bolt.]

I think it's your fierce independence (not a bad trait!) and something if how that impacts the relationships between states and with your federal level.

 

I also think that dual-party politics almost obligates side A to whip up vehement oppositionalism to anything side B proposes -- not just because it's worth opposing, but maybe just for a chance to deflate the enemy.

 

I'm also beginning to understand that there are two fundamentally different ideas of what govt is "for" and how it should operate -- making it hard to come up with move forward on any kind of platform that could be acceptable overall.

[liber]

Yes, but here in the US we pay our taxes, AND our monthly insurance premiums, AND our deductibles, AND whatever percentage of treatment isn't covered by insurance, AND for procedures that are not covered by insurance… I would venture to guess that after adding all of that up we are paying much more in the US for far less coverage. 

 

This is a really interesting thread. Loving all the info. Makes me want to move the 300 or so miles up to Canada, frankly. ;)

 

Well you get what you pay for.  You probably get seen quicker than you would in Canada. 

 

I'm in the US now and the difference is night and day.  Yes we do have excellent coverage.  However the quality and the thoroughness of visits were night and day.   My dr. visits in Canada were very inferior to what we have received here.

[Julie Smith]

A wiki comparison of the health care systems of Canada and the United States

 

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

 

[Dory]

Now I want to move to Canada. I just learned that students in Canada are outperforming American students, including those in affluent US schools. Why can't the US get it together?

 

It's not all peaches and cream up here, but the more time I spend with the in-laws south of the border, the more thankful I am for the country I live in. No shortage of work up north here so far either.

[swellmomma]

Really? I don't want my child hurt period. I'm not a helicopter parent, but whether the health care was already paid for through taxes or not would have zero impact on how I would monitor my kids. I have never thought, oh, I'd better stop ds from doing _______ or I'm going to get a large medical bill. I also don't know anyone who has ever sued someone over an injury.

 

I also have to wonder about the Canadian poster who used to be here a lot and had the horrible nerve trouble with her arm. I can't remember her name, but I do remember her frustration not only with the arm, but with simply getting care for a pregnancy she was well into after a move.

 

The comments about not being able to decide which doctors you will see and having to wait are deal breakers for me. I have to wonder what type of health issues people have had who are happy with that type of care. Sure, it's great for a broken arm, but what if you have more ambiguous health problems like Lyme? My family has experienced a myriad of health issues that have been difficult to find the right treatment for even here. I can't imagine having to get permission from a doctor to see another doctor, but I guess I have very little faith in the medical profession anyway.

 

Are you able to pay out of your own pocket to see another doctor if you have an urgent healthcare need that your system does not feel is urgent or does not recognize?

 

The issue with medical care for Imp was that she had to go see particular specialist deemed by Workers comp because it was an appeals thing.  She lived in the middle of butt f*uck no where and had to travel to see the specialists and couldn't.  That wasn't a health care issue, that was a worker's comp issue, a completely different gov't agency that is supposed to protect workers if/when they get injured on the job but which was not protecting her but rather causing issues.  Finding an OB was the same.  YOu need a referral to an OBGYN BUT any walk in clinic can do that.  The problem was she lived hours from a walk in clinic.  She was not living in a town, she was out in a provincial park and could not drive to appts.  Again that is not a healthcare issue that is a geography issue.

 

To answer about paying out of pocket, yes to an extent, in that you can pay for a private company to do your MRI for example if you do not want to wait months for a free one they feel is not urgent.  My sister did that when she got her MRI for her pituitary tumor, I on the other hand will likely just wait and get mine for free (also for a pit tumor but a different kind, so the wait times for the 2 are different as the disorder I am believed to have is more risky than the one she has been Dx with).  Shrinks, you can pay to see privately quite quickly rather than wait for the referral to see the one that is covered by health care etc. 

 

When it comes to referrals I have not had much issue with them.  I often have looked into who I would be willing to see in a particular field and make that clear when I advocate for myself to have the referral made.  The shrink ds15 is scheduled to see I selected, talked with the receptionist, who talked to the shrink and got it all worked out before I phoned my ds's ped and asked for the refferal.  We did not even go in, I phoned, told the receptionist the dr had to do this and why, and the fax # for the shrink and he did.  He did the same with the urologist and that urologist put one in for the ENT and the ENT put him in for the sleep study.  One thing leads to another.  In the case of that trail I did not check into which dr's first, all were out of the children's hospital so I trust the care they are giving my son.  If you know how to advocate for yourself and your family the referral process is not a big deal.  If you have found a GP/ped you trust again you trust their judgement because they can request the timeline the patient is seen by the specialist and can call in to have you/your child moved up.  YOu can also be put on cancellation lists(which I always do) so even if they say "oh your appt is in 3 months on x day" you can get a call the next day saying "we have a cancellation for noon tomorrow can you make it".  We have shortened our wait times considerably doing that and once you get that inital appt you are a regular patient and can call and book an appt for all follow up anytime.

[QueenCat]

Well you get what you pay for.  You probably get seen quicker than you would in Canada. 

 

I'm in the US now and the difference is night and day.  Yes we do have excellent coverage.  However the quality and the thoroughness of visits were night and day.   My dr. visits in Canada were very inferior to what we have received here.

 

I'm in the US........... Ds is on a waiting list to see a specialist.......... we were told he should get to see the doctor in July 2014. This was in October. It's not an emergency but it is ongoing care that he really needs. His doc retired...................

[bolt.]

All the hospitals would be open to working with all the doctors, if there were to be any reason for them to need to work together... There are no affiliations / non-affiliations, though there might be some established relationships and/or a lack of established relationships.

 

Doctors who provide hospital-type care would probably have a single hospital as their location where they are doing that: example, a cardiologist wouldn't have an office in a strip mall and go out to multiple hospitals on a daily basis. S/he would have an office in or near one hospital, maybe being in a cardiology department, and would be treating people who at that location.

 

(The patent's family doc would be kept up to date, files would be transfered, consultations might be needed, but would not be acting 'as a cardiologist' for their patient.)

[Dory]

Well I typed up a long reply and then got a 504 error message.  Long story short I had the same GP for 34 years, my mom started seeing him when she was pg with me, he delivered me and continued to be my dr right through 3 of my pregnancies though by then he no longer did delivers.  He retired a couple years ago now.  He was in a large clinic and each dr took a turn as dr on call each day so I could just walk in to be seen if I could not get an appt with him as quickly as I liked.  The kids ped is in an office with 2 other dr's, they see their own patients, no swapping of drs generally, they just share the space and overhead costs.

 

As for hospital privileges, my old GP only had them at the hospital in the city he worked in, if I needed to be seen in a larger one in the bigger city I just saw whomever was on call when my referral was put in or when I got there kwim

 

I needed to see a specialist for my dd's delivery. My doc asked me if I wanted the same specialist that delivered me and three of my siblings. My family doc is also the same one that sees my mom and most my siblings that still live in the area.

[AimeeM]

 

 

My mom had what she thought was a cardiac problem and she was able to get into a cardiac clinic asap and do a ton of testing without any waits.  Meanwhile, my mil felt her wait for an MRI was too long, so she went to a private clinic and paid for it herself.  

 

But doesn't that mean that healthcare isn't "fair", and that quality of care, like in the US, may depend on how much money you have to burn? Someone with less money wouldn't have the option of paying a private clinic for immediate testing.

 

[Coffeetime]

Well you get what you pay for.  You probably get seen quicker than you would in Canada. 

 

I'm in the US now and the difference is night and day.  Yes we do have excellent coverage.  However the quality and the thoroughness of visits were night and day.   My dr. visits in Canada were very inferior to what we have received here.

With the variance of replies from Canadians on here, I wonder if this has more to do with locality than with the system itself. 

I have lived in areas where this would be the case in the US- low quality doctors, inferior care, long wait times, etc. 

I have lived in areas where I have amazing doctors- thorough, caring, get you in quickly and work to develop a good relationship. 

Same system, same coverage- vast difference in care. 

Thoughts?

[bolt.]

Yes, it depends a lot on where you live.

 

The provinces are independent, but reasonably similar in what they provide, and sometimes how they do so.

 

The major distinction is that it's tough to be rural, and it's even worse to be rural in a low socio-economic area. The system works best in urban areas because of the concentrated accessibility of all kinds of services, rather than people 'making do' with what's available locally.

[Hot Lava Mama]

That depends on the province. In Alberta, it is honestly free.

 

Not possible.  Do the doctors work for free?  Do the contractors build the hospitals for free?  Do the labs do the tests for free?  Are all the medical equipment build for free?  Is the electricity provided for free?  Somebody pays for it.  You just don't see it.  Even if the answer was "yes" to all of the above, don't you see that all those who worked for "free" actually paid for it?

[LucyStoner]

I don't understand the highlighted. No hospital can turn away a person in need (unless it's a private hospital) - regardless of their ability to pay, a person receives medical care. They may have a bill afterwards, but their care isn't dependent on having a job, or money. In fact, from what I understand, that is one reason our medical bills are so high - anybody can walk into an ER and receive care, even if they can't pay.

My father was uninsured from the time he was downsized at 62 until he was age eligible for Medicare. If he were having an urgent situation, yes he got a limited amount of care in an emergency setting. But, as a very low income man with MS, he went without needed but cost prohibitive medications and regular physican care and his daily physical condition deteriorated greatly. Honestly, if not for Medicare and the VA kicking in for him, he'd quite possibly be dead. I shudder to think of him being without a job at 52 vs. 62 and just three years from Medicare.

[LucyStoner]

Oddly, in the United States we spend more TAX dollars per capita on healthcare than they do in Canada. For our public expense outlay we get health coverage for seniors and some poor people and government workers and they get healthcare for everyone. Makes a lot of sense, right?

[Julie Smith]

Oddly, in the United States we spend more TAX dollars per capita on healthcare than they do in Canada. For our public expense outlay we get health coverage for seniors and some poor people and government workers and they get healthcare for everyone. Makes a lot of sense, right?

 

I saw this mentioned on the wiki.

 

Makes you think doesn't it. 

[NoPlaceLikeHome]

Most doctors here (in the US) have hospital privs - they can come into the hospital and treat their own long term patients. When I had my c-sections, the private practice OB I saw off campus came in to do my surgery (into the hospital); he needed hospital privs to do so.

When my son saw a private practics pulmonary team, that team had the right to come into the hospital and oversee my son's treatment.

Actually many family doctors and general practitioners these days do not make hospital rounds since many hospitals are using physicians who work for the hospital to admit and manage patients. Now family docs will initially talk to them by phone but the hospital doctor will be the one calling the shots generally anymore. Of course, with surgeons and some some specialties it is a different story.