Canadian Health Care, Healthcare Access & Health Insurance, Part 1

On the first day of this blogathon, I asked people for suggestions on blog topics. Friend and colleague Jennifer Fink (Blogging 'Bout Boys) suggested that I write from the Canadian perspective of health care, healthcare access and insurance. So here I am. It's a touchy subject for many, so I'll see if I can explain how I see it without stoking any flames. There is a lot to cover, more than can be done in one blog post. So this is part 1 - a basic explanation of how the system works.

I have seen many sides of the Canadian healthcare system, from being a patient, a parent of a patient, a child of a patient, a nurse, and an administrator within a nursing department. While I know the system isn't perfect, I wouldn't give it up for anything.

from MorgueFile.com

Because of my work online, I interact with many Americans, of all socioeconomic and education levels. I've watched many discussions go on about the perils of socialized medicine and much misinformation that is spread because people don't know the facts but they believe they do. Unfortunately, spreading misinformation does everyone a disservice, everyone.

The Canadian medical system is national health insurance system run by the provinces and territories. The federal government, located in Ottawa, Ontario, distributes funds to the provinces. While medical care falls under provincial jurisdiction, there are some rules that the provinces must follow as per federal guidelines, the Canada Health Act. The provinces may add to the services. For example, a province may decide to have a drug insurance plan to ensure that all residents are guaranteed a minimum of medication availability.

Why Medicare Isn't "Free"

Canadians - and people in other parts of the world - often refer to Canadian health care as free. It's not. Our tax dollars pay for it, federally and provincially. We pay for it every day.

There is abuse to the system. People from other countries have been known to come to take advantage of the health system. Before the province of Quebec required photos on their Medicare cards, there were thousands of people who had fake ones or ill-gotten ones in their possession. People lent their cards to friends who needed to go to an emergency room or clinic. This added up to millions of dollars being stolen from the Canadian tax payer. When the cards became photo ID cards, the number of applied for cards dropped dramatically, said Medicare officials.

What Medicare Provides

Medicare allows Canadians and landed immigrants the right to see a doctor or healthcare professional in a hospital, clinic, or office without having to pay for it. Certain types of visits are not covered by the system though - there are limitations. If you have been hired for a new job and your employer wants a pre-employment physical - this is not covered by Medicare; the doctor must be paid as he or she cannot charge the system for this service. If you are travelling and you need vaccinations, this isn't covered. Many extras provided in a doctor's office aren't covered by the system either; each province is a bit different.

However, a yearly physical is covered. Blood tests done in a hospital and provincially approved clinics are covered, blood tests done in private labs aren't. Specialized nuclear testing in a hospital is covered, not in a private clinic. Physiotherapy in a hospital or healthcare facility is covered; physiotherapy in a private clinic is not - and so on.

The goal is to ensure that everyone is covered by a certain level of care. This doesn't always work as intended, unfortunately, as waiting lists for the publicly provided services can be staggering at times.

If you have been injured or are ill and you go to an emergency department or walk-in clinic, you must have your health insurance card with you. If you don't, you must pay for the services rendered, even if you can prove that you are a Canadian and a resident of the province. If this happens, you must apply to your health insurance board for reimbursement.

Glitches in the System

Ideally, the system was supposed to provide equal access to medical care across the country. But one of the drawbacks to the program and provincial control is associated with how much the provinces pay their healthcare professionals. A doctor in British Columbia gets paid more per patient visit than does a doctor in Quebec. Therefore, a Quebec resident who must see a doctor in BC may be required to pay an amount in addition to the fees the doctors claim from the Quebec health board.

Other glitches aren't as minor. Waiting lists are long for some procedures. Some parts of the country don't have certain types of specialists or equipment. While these are not acceptable, particularly for life-threatening issues, these aren't limited to Canada. I have heard from many Americans about waiting lists for specialists that are months' long. I've heard from others that they must travel to other parts of their state to be able to see a certain type of expert. In countries as big as ours, this need to travel, as frustrating and painful as it may be, is often inevitable.

Nurses are overworked and underpaid. This is a story, again, not unique to Canada. There is a nursing shortage - again, not unique to Canada. There are more and more demands on the available resources - need I repeat about it not being unique to Canada?

The Canadian system is far from perfect and we are working on trying to find solutions.

My next post on this topic will talk about how we work private insurance in with our national health insurance.