Tuesday, July 14, 2009

Canadian Universal Health Insurance: the Common Prenotations

During the many years I've been an professional insurance broker, I've had more than enough of occasions to answer questions concerning the ups and downs of both the US and Canadian health care system. Although non of them is hundred per cent, I absolutely hate some of the lies that are spread about the Canadian system. Let's have a look at some of them.

"The health system in Canada is much more expensive than the system in the USA."

To begin with, there's this faulty assumption about the cost. It is often claimed that the Canadian system costs more than the US system, but in fact while Canada spends only 10% of its GDP, covering 100 percent of its population, the USA spends over 15 percent GDP, while at least 15 percent of Americans is not covered at all and even more Americans are left with not enough coverage. For example in 2005, the US government spent US$6,401 per capita on their health expenditures - that's almost twice the sum spent in Canada that year - US$3,359. (picture:pills by erix!)

"In Canada, it's up to the administration to make a decision who gets the treatment."

That's totally wrong: the only people in charge of these decisions are in fact the physicians. On the other hand, the situation is quite different in the States, where in fact it is up to your insurance administrators to determine what treatment you are allowed to get, never mind what you doctor thinks.

"The plan only covers the bare basics, so you end up paying a lot on any extras anyway."

Every province has its own rules concerning what is and what is not included by the public health insurance. The least you can count on is that the physician's fees and all the hospital procedures will be included in the insurance - which are generally the most costly items. Other stuff like medical equipment, dental & vision care would generally not be included. Because it's not too hard to average the cost of these extras, since all those big troublesome items are already covered by the national health insurance, number of insurance companies offers some additional low premium insurance that takes care of all these extras. For example the FlexCare Program from Manulife. All in all, to get the same level of service in the USA as in Canada, the Americans have to pay much much more. The system is simply running better in Canada.

"The biggest problem with the Canadian system are the long waits. In fact, Canadians rather travel to the US for their treatment."

The situation doesn't differ that much from the one in the States, because the waits associated with some specialist treatments (up to four weeks some selective surgery takes even longer. On the other hand, all urgent treatment, you will get it fast one way or the other. And, unlike in the US, noone cares whether you're rich or poor. For example, if you cannot get urgent care you need (i.e. surgery) and you cannot get it as fast as it is medically required, you will most likely be sent to the US - at the expense of the state insurance. If you spoke to a Canadian who rushed to the the US for their treatment and had to pay for it themselves, they most likely didn't need the treatment as fast as they wanted it.

"In Canada, the physicians work for the government. Also, you've no choice: you get your physicians picked by the government!"

Not true. The provincial government doesn’t act as an employer, since the physicians in Canada own their private practises just like their colleagues in the States, but constitutes the only insurer that the physicians have to deal with, therefore the paperwork is kept to the necessary minimum. Don't worry: you get to choose your doctor yourself.


Rositta said...

A couple of points I'd like to make. You are right, it is up to the doctor to decide what treatment you get but the wait for said treatment is horrendous. I don't know how much of my blog you have read but here is a quick synopsis. 1. I waited 6 weeks to see a retinal surgeon, paid $150 for special x-ray of said retina and waited another 9 weeks for surgery. During that wait I literally went blind in one eye and now the best it will ever be is corrected 20/25. 2. My husband injured his hand and waited 3 months to see a specialist and another 6 months for an MRI. He gave up and will live with it since the window of opportunity too repair a torn tendon is long gone. 3. I waited 2 years for a hip replacement in 2004 and searched for over a year for a foot surgeon plus three more months for surgery. I'm now on a one year wait list for knee replacement with my surgeon of choice. Of course I could have it done quicker if I went to a no name hack maybe.
4. I almost died from Tachycardia waiting for a cardiologist to refer me to the Ablation clinic for treatment.
5. Gallblader surgery, another cockup, wasn't even diagnosed properly and I had to tell them what was wrong with me. The doctors at my local hospital had egg on their face when they finally realized I was right.
Two years ago my mother died in hospital due to neglect (short staffed). A pacemaker was recommended in the first week and she waited 7 weeks. During that time she was kept in bed an as we all know elderly people who don't walk regularly loose it. One week after the pacemaker surgery she died from toxic shock. The reason, she was kept in diapers for convenience (hence my hate on for Smitherman). I have no use for the system here and if I ever became seriously ill I'd cash in my chips and go either to the U.S. or Germany for treatment. Oh yes, FlexCare...a whole other story. Pre existing conditions? Forget it. Your Birthday coming up? Rates go up. After 6 years I finanlly told them them to stuff it. And travel insurance, not even an option. Sorry for my rant and do visit again, I rant a lot...ciao

Quantum_Flux said...

There roughly the same amount of unemployed people in the USA (10% of 305 million = 30.5 million) as ther are people in Canada (33 million). Also, I heard that Canada caps off the total annual budget and so the physician will often deny service until the following year if budget money is tight. Besides that, Canadian health insurance is a percentage of a paycheck vs. being a specified amount dependent on the amount the purchaser chooses to pay.

Lorne S. Marr said...

Thanks for the comments. What to add, Rositta? Horror stories...