Wednesday, May 9, 2012

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.

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.


Kathe Lieber said...

Sure there are glitches, but in general our system works pretty well. I've had two total knee replacements in the Quebec health-care system, complete with physio and rehab - all taken care of. If I were American, I'd be bankrupt in a wheelchair (I'm self-employed). I believe that every country needs to take care of the health of its citizens.

Marijke Vroomen-Durning said...

I agree Kathe. It's been there when I needed it - and I've needed it several times.

Have there been problems? Sure, as when my mother's care before Christmas was deplorable and I had to be in there every day to ensure things were handled properly. But again, this can happen anywhere.

Jennifer Patrick said...

Thanks for this post! As an American, I'm very concerned about the availability of health care for everyone in our country. No system is perfect, but my friends and I talk often about the benefits of the program in Canada. It's something we'll be struggling with for a long time.

And you are right, nurses are overworked everywhere. Some of my closest friends are nurses (I worked at a hospital in a management, not health care provider, capacity and know how hard they work!

I'm going to share your post with my facebook readers!

Jennifer (from the blogathon)

Marijke Vroomen-Durning said...

Thanks Jennifer. I appreciate you sharing the post. If people make decisions, I want them to have at least the basic information, not the rhetoric that can take over sometimes.

If they still are against the Canadian system, that's their decision. At least they have the right information though.

Annie Logue said...

The American system is beyond broken.

But I have heard that one reason for the nursing shortage here is a shortage of nursing instructors. Interesting, huh? My aunt taught nursing, but she had been retired for 20 years! (Still, it was nice when my father recently had surgery and one of her former students was working on his floor.)

Marijke Vroomen-Durning said...

I have heard that too Annie, that there aren't enough nursing instructors. Personally, I think that they need to work on the quality of nursing instructors as well.

It may be that I'm not objective, but I came across so many ineffective and horrible nursing teachers over the years that I wonder why so many of them are in the field.

Notice to teachers: This isn't the army. You don't need to break a person before they can become a good nurse.

Babette said...

Ha, glitches, perhaps, but I kept asking: why don't we just do it the way the Canadians do it? Seems to work for them.

There are bumps with ALL systems. I'll take your bumps over the US bumps ANY day.

Jennifer Fink said...

I just found this post, Marijke. I'm glad you wrote it! It's definitely nice to hear more from someone who lives within the system.

I'd love to hear more about the nursing shortage. Is that a relatively new thing in Canada? In the mid-90s, I worked in North Carolina with 2 new Canadian nurses. At the time, neither could find a job in Canada, and they said that was pretty common there.

Marijke Vroomen-Durning said...

Thanks for stopping by Jenny. Our nursing shortage has been around for a while now, partly because there aren't enough students enrolling, but also because there are more nurses leaving the profession or working part time.

Some provinces have a harder time attracting nurses than others. In Quebec, for example, you have to be able to speak French, so this cuts down on the number of nurses who can come here from other parts of the country or world.

It's not an easily solved problem, for sure.