Canadian Health Care

lukin2006

I am just curious to know if we in Canada are getting our moneys worth when it comes to healthcare.

I personally believe that we are paying for a cadilac and only getting a pinto.
We pay very high taxes in Canada.

Some examples why I say this.
-thousands of fellow canucks have no family doctor and can not find one
-if you have no doctor, you must use hospitals or walkin clinics ( if available - until recently none were available where I live)
-hospital wait times are usually 6-10 hours for non emergency conditions
-it can take months to get in to see an orthapedic surgeon and then many more months before the surgury is done.
-as a matter of fact most specialist take months to see.
-if its life threatening I do trust that we will be taken care of.

However I know a few people who would like thier non life threatening problems taken care, so they do not have to live in pain and it gives them peace olf mind.

This is an open debate. Also curious to hear from people from other countries about thier health care.

hippiemom

I live in the U.S., and am currently in a battle with my insurance carrier (Aetna) over my chemotherapy treatments. Despite peer-reviewed articles in the New England Jounal of Medicine and other journals, and a recommendation from the National Cancer Institute (dated Dec. 05) that stage III ovarian cancer patients receive the treatment I've been getting, they are saying that the treatment I've been getting is "experimental" and not covered. In essence, this means that some twit with an associate's degree in accounting from his local community college sees fit to second guess my Yale-educated oncologist regarding what is likely to keep me alive. If I'm not successful in my appeal, I'm going to have 6-figure medical bills. The only way I'll be able to pay that is to sell my house, should I be lucky enough to live so long. If I'm not that lucky, the bills would be taken from my life insurance proceeds, so I'll leave my kids with nothing.

I know the system in Canada is far from perfect (I worked 10 years for a Canadian company), but does this happen in Canada?

lukin2006

hippiemom wrote:

I live in the U.S., and am currently in a battle with my insurance carrier (Aetna) over my chemotherapy treatments. Despite peer-reviewed articles in the New England Jounal of Medicine and other journals, and a recommendation from the National Cancer Institute (dated Dec. 05) that stage III ovarian cancer patients receive the treatment I've been getting, they are saying that the treatment I've been getting is "experimental" and not covered. In essence, this means that some twit with an associate's degree in accounting from his local community college sees fit to second guess my Yale-educated oncologist regarding what is likely to keep me alive. If I'm not successful in my appeal, I'm going to have 6-figure medical bills. The only way I'll be able to pay that is to sell my house, should I be lucky enough to live so long. If I'm not that lucky, the bills would be taken from my life insurance proceeds, so I'll leave my kids with nothing.

I know the system in Canada is far from perfect (I worked 10 years for a Canadian company), but does this happen in Canada?

Thanks for your reply.

First off I would like to say, I really hope you defeat your illness, and my thoughts and prayers are with you.

I believe it is considered experimental, you need approval from the (Ontario Health Insurance Plan), I could be wrong, maybe someone knows for sure.

sponger

hippiemom wrote:

In essence, this means that some twit with an associate's degree in accounting from his local community college sees fit to second guess my Yale-educated oncologist regarding what is likely to keep me alive.

You are Yale educated and you really think that a Provider would let someone with an AA make those kinds of decisions? Whoever is screwing you is probably very well educated, but that in no way means to imply that he/she is honest. Their aim is to profit regardless of what common sense may dictate. I'm sorry to hear about your situation. But, I just thought you might like to know that they are screwing you on purpose, not because they are ill-informed.

hippiemom

sponger wrote:

You are Yale educated and you really think that a Provider would let someone with an AA make those kinds of decisions? Whoever is screwing you is probably very well educated, but that in no way means to imply that he/she is honest. Their aim is to profit regardless of what common sense may dictate. I'm sorry to hear about your situation. But, I just thought you might like to know that they are screwing you on purpose, not because they are ill-informed.

I am not Yale-educated, my oncologist is. I don't know for certain, but I'm guessing that the insurance adjuster from Aetna does not have a Ph.D. from Yale in any field, much less oncology. Speaking as someone with cancer, I am much more interested in the opinions of oncoligists than accountants.

And I'm quite aware of the myriad ways in which Americans get screwed, believe me.

depopulationINC

hippiemom wrote:

I know the system in Canada is far from perfect (I worked 10 years for a Canadian company), but does this happen in Canada?

yes it happens all the time. if its not approaved its not approaved. There was just a big todo about a guy with cancer. my numvers are likely off, but the jiff of it was that he was fighting for treatment. he has like 6 months to live, and there is treatment that would extend that 3-4 years, but they wont pay because it is not a cure / wont cause remission.

essencially they said "yes, we know that this money will extend your life, but it just dont seem worth it"

shitttttyy deal

depopulationINC

sponger wrote:

You are Yale educated and you really think that a Provider would let someone with an AA make those kinds of decisions? Whoever is screwing you is probably very well educated, but that in no way means to imply that he/she is honest. Their aim is to profit regardless of what common sense may dictate. I'm sorry to hear about your situation. But, I just thought you might like to know that they are screwing you on purpose, not because they are ill-informed.

no, they would be an insurace adjuster.

sponger

depopulationINC wrote:

no, they would be an insurace adjuster.

That is incorrect. An adjuster definitely does not determine what procedures should or shouldn't be covered. Company policy dictates that. For example, an adjuster would look at the claim and compare it to company policy to determine whether or not it is covered per the policy.

Here's an example of adjuster work in other industries:

Adjusters may consult with other professionals, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

http://stats.bls.gov/oco/ocos125.htm

Common sense would dictate that determining whether or not a medical procedure is "experimental" is definitely something that would require the opinion of "other professionals" such as doctors..etc.

Adjusters are just the messengers.

In the case of medical insurance providers, the doctors who are acting as consultants are employees of the insurance company. I'm sure you can figure out how things work out from there.

depopulationINC

sponger wrote:

In the case of medical insurance providers, the doctors who are acting as consultants are employees of the insurance company. I'm sure you can figure out how things work out from there.

yes, but also, the drugs MUST pass regulatory boards to be on any insurance company's policy coverage (ie fda). well, I suppose they could cover electives, but why would they, but they cant afford that becase A- experimental drugs are costly, B- opens the door to too many loopholes within contracts.

chopitdown

hippiemom wrote:

I am not Yale-educated, my oncologist is. I don't know for certain, but I'm guessing that the insurance adjuster from Aetna does not have a Ph.D. from Yale in any field, much less oncology. Speaking as someone with cancer, I am much more interested in the opinions of oncoligists than accountants.

And I'm quite aware of the myriad ways in which Americans get screwed, believe me.

most of the companies do have a doc at some level making a call...granted those physicians prob get bonuses for keeping costs down so it's not surprising that they deny stuff right away. They do it all the time. I'm sure this is pissing off your doctor too; esp since there is evidence based, peer-reviewed literature to back up the treatment you guys chose.

farfromglorified

When it comes to buying something, actual choice is usually a prerequisite for me. But hey, maybe I'm nuts.

lukin2006

There are tons of examples where the health care sysyem is failing people in Canada.

The first misconception is that its free, thats just not true, we pay extremely high taxes and in some provinces we pay a health care premium and employers pay a health care tax. In the province I'm from (Ontario) the current government introduced a health care premium early in thier mandate.

They claimed this would reduce wait. What a joke, thousands still have no doctor. If you are in pain, needing orthopedic prcedures done you can wait a year or more. Most common procedure's done by a surgeon can take months just to see the surgeon.

Many Canadians now opt to go to the States and pay for it themselves, just so they do not have to live in pain.

chopitdown

beemster wrote:

There are tons of examples where the health care sysyem is failing people in Canada.

The first misconception is that its free, thats just not true, we pay extremely high taxes and in some provinces we pay a health care premium and employers pay a health care tax. In the province I'm from (Ontario) the current government introduced a health care premium early in thier mandate.

They claimed this would reduce wait. What a joke, thousands still have no doctor. If you are in pain, needing orthopedic prcedures done you can wait a year or more. Most common procedure's done by a surgeon can take months just to see the surgeon.

Many Canadians now opt to go to the States and pay for it themselves, just so they do not have to live in pain.

The waiting times in the states are sometimes a concern as well, although if you have a referral you get in much quicker. If I wanted to see one of the big docs in a big city it would take 6 mos sometimes, if you just called w/o a referral from another MD. If you have someone else make the appt, the wait time is MUCH less and the time to Surgery is usually much less also. The down side is the insurance company and having to play that game. Sometimes it works fine but as soon as teh costs get high, it's a whole lot harder to have the insurance company follow through.

thankyougrandma

Everyone is covered and that's the main pro-argument, our system must be corrected and reformed, but not looking down south to do it, we must look at some europeans country who have achieved a great healthcare social system.

In Canada, waiting list are getting shorter, it's a matter of working on them and erasing the names that should not be on the list anymore, the waiting list in Quebec have been reduced just by doing that, it's stupid but so simple. Doctors must be more available for practicing (erase the stupid quotas), immigrants doctors must be recognized, chirurgical room must be made available (build hospitals, clinics) and we should open more spaces in schools for nurses, doctors and all these guys... just my two cents...

chopitdown

thankyougrandma wrote:

Everyone is covered and that's the main pro-argument, our system must be corrected and reformed, but not looking down south to do it, we must look at some europeans country who have achieved a great healthcare social system.

In Canada, waiting list are getting shorter, it's a matter of working on them and erasing the names that should not be on the list anymore, the waiting list in Quebec have been reduced just by doing that, it's stupid but so simple. Doctors must be more available for practicing (erase the stupid quotas), immigrants doctors must be recognized, chirurgical room must be made available (build hospitals, clinics) and we should open more spaces in schools for nurses, doctors and all these guys... just my two cents...

I'm somewhat familiar with the quota system and doctors. I'm sure doctors would be more willing to work if they got paid for seeing the patients they do...correct me if i'm wrong, but they just have to treat a certain number to get their paycheck and any number of patients over that is in essence work done for free. No one truly likes to work for free esp if you can meet the quota in 6 or 7 mos. Docs in the US do a lot of pro bono work but I'm willing to bet it isn't 5 or 6 mos worth of free labor.

Heatherj43

hippiemom wrote:

I live in the U.S., and am currently in a battle with my insurance carrier (Aetna) over my chemotherapy treatments. Despite peer-reviewed articles in the New England Jounal of Medicine and other journals, and a recommendation from the National Cancer Institute (dated Dec. 05) that stage III ovarian cancer patients receive the treatment I've been getting, they are saying that the treatment I've been getting is "experimental" and not covered. In essence, this means that some twit with an associate's degree in accounting from his local community college sees fit to second guess my Yale-educated oncologist regarding what is likely to keep me alive. If I'm not successful in my appeal, I'm going to have 6-figure medical bills. The only way I'll be able to pay that is to sell my house, should I be lucky enough to live so long. If I'm not that lucky, the bills would be taken from my life insurance proceeds, so I'll leave my kids with nothing.

I know the system in Canada is far from perfect (I worked 10 years for a Canadian company), but does this happen in Canada?

This reminds me of the many threads about insurances and getting sick wiping people out. Do you remember them? FFG was in a lot of them and the talk went something like....an illness doesn't have to wipe you out, all you have to do is buy the right insurance, etc.?
I kept saying that insurances don't pay. He kept saying they HAVE to. I kept saying they only HAVE to pay what the contract says...and THEY are the ones who decide if you really are sick, and what treatment they will pay.
I had paid into, through my work, long term disability, and when I got sick, they didn't pay. He said they have to. I tried to explain that some person at their company makes the decisions and will override what a doctor says and they come up with things so they don't have to pay.
I had a niece who died back in '92. Her disability was denied, and she died!!! It was okayed after her death...so my sister did get to pay those bills, but geez...she was denied as not being sick...she fricking died!!!! How sick did they want!
People think they are secure financially and if they get sick they find out they really weren't as secure as they thought.
I so tried to explain this in many threads.

I wish you luck!!! Its bad enough to be sick and dealing with that, then to have to deal with those fricking insurance people is just wrong!!!
I remember asking the adjuster what medical degree he had, he tells me that some lady at the company made the decision, so I ask what kind of doctor she is...she was an LPN!!!!
They overrode a few doctors that had diagnosed me and made up their own diagnosis. They never did pay. I did have to sell my house and all that. It was 2 years before any government disability began.
I was so pissed, and sick at the same time...and trying to pay the bills, while fighting with that fricking guy in some office in Florida.
I am so sorry you have to deal with this end of this... *aggravated sound..argh*.

lukin2006

chopitdown wrote:

The waiting times in the states are sometimes a concern as well, although if you have a referral you get in much quicker. If I wanted to see one of the big docs in a big city it would take 6 mos sometimes, if you just called w/o a referral from another MD. If you have someone else make the appt, the wait time is MUCH less and the time to Surgery is usually much less also. The down side is the insurance company and having to play that game. Sometimes it works fine but as soon as teh costs get high, it's a whole lot harder to have the insurance company follow through.

If we don't have a referal, a specialist will not see you at all.

Another problem are Docs that don't like to refer you to specialist if they feel it minor. My question is, how do they know? Let the specialist decide.

I am having an ankle problem, and all the Doc said was the x ray was normal, and that a surgeon wil not help you. Mind you, I went three times
before it was even x ray, so the OHIP got billed three times for the same problem, and pobably a fourth because I will likely need to seek medical attention elsewhere.

This system of ours is very frustrating. There needs to be changes, but no government has the intestinal fortitude to make the changes.

The first change that needs to be made is to pay the health care providers closer to what the US health care providers make. this will allow us to retain
healthcare workers and recruit health care workers.

chopitdown

beemster wrote:

If we don't have a referal, a specialist will not see you at all.

Another problem are Docs that don't like to refer you to specialist if they feel it minor. My question is, how do they know? Let the specialist decide.

I am having an ankle problem, and all the Doc said was the x ray was normal, and that a surgeon wil not help you. Mind you, I went three times
before it was even x ray, so the OHIP got billed three times for the same problem, and pobably a fourth because I will likely need to seek medical attention elsewhere.

This system of ours is very frustrating. There needs to be changes, but no government has the intestinal fortitude to make the changes.

The first change that needs to be made is to pay the health care providers closer to what the US health care providers make. this will allow us to retain
healthcare workers and recruit health care workers.

That would be frustrating. A lot of Gen med docs do have the knowledge to make decisions but you're abosolutely right b/c people do specialize b/c it's impossible to know everything and be competent about everything.

On a side note, can you get a referral to a physical therapist for the ankle (the lower extremity and the shoulder are 2 things i've done a decent amount of work with)...just b/c it's not fx doesn't mean it's not a host of other things. Your doc is right, a surgeon won't cut most likely, but will be much better versed in ortho issues...hell, even a non operative sports med guy would be good.

I think you're right in terms of the pay, you have to be able to recruit and keep top notch docs if you want top notch care. And if docs can travel south to make much more money, most will.

RockinInCanada

Okay here I go......

1st thing first to address....hippiemom, my mothers chemo was covered in Canada and there were no hassles at all, and it was cutting edge. I went up to the cancer wards precription window gave them the paper and an hour later I left with my mothers medicine, nothing to it.

2nd thing Healthcare reform in Canada:

- Our current systen is flawed but is far from broke. The system in the USA is no better beemster, where we pay high taxes they pay some insane health care premiums and some of the time you are given a list of doctors from the insurance company on who you must see if you want to be re-imburesed. Plus the USA system is flawed that access to healthcare is essentially only for the people with money to spend. In Canada we allow everyone equal care but we need to adjust methods of delivery, where in the USA if you are poor (and I am not talking a free loading poor...but a person who still works three days a week while taking care of a child) you are going to be screwed from anything from a broken leg to at worse cancer. In Canada no matter the the issue you will receive treatment.

- I agree we do need to make changes. One I suggest is allowing doctors to practise in the private sector only after completing a minumum of 35 hours a week. One can go on to say that will not allow much time for the doctor to practice privately, my arguement that I honestly believe is that the time alloted for private use (assuming 75% do go smei-private) will be directly proportional to those Canadian citizens that will actually use the private system. I for one will refrain from any use of this system, but that is my choice.

- Private clinics can offer specilists, MRI's, X-Rays, and consultation. This right here will decrease the public list for these needed applications. Surgeries such as joint replacement, and minor non-life threatening injuries should also be available to the private side to decrease the public waiting list. I call on you to research the Alberta study where a three month trial was completed to see the effect of allowing people to pay for hip/joint replacement and how that would decrease the public list. It is estiamated that the public list went down approx. (do not quote this as gospel) as 25%. Which is a large number and proves further study IMHO.

- All life threatening injuries will be covered only through the public sector, no person regardless of their income should have their life prioritized over someone who simply makes less money, that is the soul and essence of our system and we cannot take that away. Some will say I am by proposing some pay services I go against this ideology, but the point is there that there is no lives at stake and the paying will drastically decrease the wait for the public side...win win situation. We have to give a little somewhere to improve the system as a whole. This inlcudes all forms of transplants, cancer therapy, heart surgeries, etc. You know what I am getting at.

- Sorry but taxes remain the same...to try to quantitate someone's use or non-use of the public/private system would create a bureacratic nightmare similar to that of the gun registry. So much time would be spent arguing the logistics of everything it would be horrible one can only imagine. If you have a better plan for this please let me know. Therefore the public system, which is and always will be the primary system, is still taken care of.

- Foreign doctors should go through rigourous testing to verify their education, this can be done quite easily and will give access to those that right now are shot down completly.

In a nutshell I think reforms are necessary, however we must not look south that system is deplorable and once you take into account health care premiums and restricted access things are not as rosy. We must look at the European systems, which happen to consistently rank in the top groups for healthcare provider.

RockinInCanada

Plus I may add beemster that the reason that the government does not making sweeping changes is the fact that healthcare in our country is something that most Canadians feel passionaltly about the most. It would be political suicide to mess around with things too much...our system will never be like the south, thank God at that. But it does need changes realize though that there is a very line to walk on and in the end voters will matter most to these people....

lukin2006

thankyougrandma wrote:

Everyone is covered and that's the main pro-argument, our system must be corrected and reformed, but not looking down south to do it, we must look at some europeans country who have achieved a great healthcare social system.

In Canada, waiting list are getting shorter, it's a matter of working on them and erasing the names that should not be on the list anymore, the waiting list in Quebec have been reduced just by doing that, it's stupid but so simple. Doctors must be more available for practicing (erase the stupid quotas), immigrants doctors must be recognized, chirurgical room must be made available (build hospitals, clinics) and we should open more spaces in schools for nurses, doctors and all these guys... just my two cents...

I agree, all your point are valid,