Canadian Healthcare

[StargazerParticipant 12505]

Can one of our Canadian brothers or someone who is familiar with the topic answer a quick question for me?

I was speaking with a female friend of mine recently about how the Canadian healthcare system works. She and her husband lived in Calgary for three years and she was touting the benefits of what I assumed to be a single payer system but then she said you could see a private physician if you’re willing to go out of pocket for the privilege.

My question to her, which she could not answer, was what are the benefits of doing so and how do they work? I’m assuming there must be some benefit to visiting a private physician… whether it be faster access, ability to receive more costly and risky procedures, higher quality of care… something that makes it worth paying out of pocket. Specifically:

1) Do private physicians get to set their own prices so they can make more than a public physician by seeing fewer patients, thereby providing more rapid service?

2) Does the government pay a portion of the bill for a private physician equal to what a public physician would get paid and then the individual pay the difference?

3) Does the government fix prices of medications, procedures, tools and consumables (food, bandages, etc) for both public and private physicians or do private physicians have pricing flexibility across the board?

4) Does the government decide who gets to be a private physician and who has to be a public one or is there some percentage split of time serving public and time available to provide private services for everybody?

I’d be happy to read up on this myself if someone has a link that summarizes the basics of how this works, otherwise thank you in advance for your time and attention.

[chirParticipant]

With Canadian healthcare its not a problem of quality, its the wait. If a patient can’t wait they have to do a private physician out of pocket.

http://www.forbes.com/sites/theapothecary/2014/06/13/if-universal-health-care-is-the-goal-dont-copy-canada/

It is by caffeine alone I set my mind in motion, it is by the beans of Java that thoughts acquire speed, the hands acquire shaking, the shaking becomes a warning; it is by caffeine alone I set my mind in motion.

[FrankOneParticipant 1417]

If you want a private hospital room, you pay extra with supplemental insurance. Cosmetic surgery and elective procedures are typically not covered.

Since prescription medications are NOT covered except for elderly or indigent, these are mostly paid for out-of-pocket, though some employers offer supplemental insurance to cover medications.

However, your essential medical care, is NOT job-dependent and there are no restrictions on pre-existing conditions.

Since dental, optometry, and medications aren’t covered, citizens still pay about 30% of medical costs. Half of that out-of-pocket, the other half from employer supplemental insurance. You aren’t allowed to carry insurance for procedures covered by the Health Care Act.

This is a pretty good reference: en.wikipedia.org/wiki/Health_care_in_Canada as is http://www.thirdworldtraveler.com/Health/PrivateCare_Canada.html

According to law, private clinics are NOT supposed to offer services covered by the Canada Health Act, but some do it anyway. Certain groups like police, military, and workers’ comp patients have long been allowed to go to private clinics. The Supreme Court said patients COULD pay for procedures covered under the Act at private clinics, if wait times were overly long. And you see some individuals, medical tourists, come to the US for a quick knee replacement, MRI, etc. One of the many ways costs are held down is by maximizing use of equipment such as MRIs, this also means longer waiting times.

Total medical spending is about 9.5% of GDP vs about 13.6% in the US (figures vary year to year).

Physicians are paid based on how many patients they see/procedures performed, for procedures covered under the Health Care Act.

Individuals typically pay nothing — other than taxes — for medical procedures or office visits UNLESS it’s not covered by the Act (eye doctor, dental, cosmetic surgery or other electives, etc are NOT covered).

Doctors can do both private clinic work and work covered by government payments.

I believe medications are negotiated by large entities to median international prices — the provinces as I recall. I’m not an expert on this but I’m quite interested in the subject, please correct me if I got any of this wrong.

[uchibenkeiParticipant 7965]

chir wrote:

With Canadian healthcare its not a problem of quality, its the wait. If a patient can’t wait they have to do a private physician out of pocket.

http://www.forbes.com/sites/theapothecary/2014/06/13/if-universal-health-care-is-the-goal-dont-copy-canada/

I would say quality is also becoming a problem. Many hospitals have to set up charities and raise funds themselves to get the latest equipment or to expand their hospitals. Like most government services, all the money goes to the bureaucracy and very little trickles down into the actual hospital. Hospitals are falling behind in terms of technology and latest services. Same thing with public education.

I bathe in the tears of single moms.

[StargazerParticipant 12505]

We discussed the extended wait times that Canadians are subject to for basic diagnostic procedures and the argument I made is that FASTER service is BETTER service. That’s true at Wendy’s and it’s a million times more true at a clinic or hospital where quick diagnosis can lead to treatment that prevents an acute problem from becoming a chronic, debilitating one (thank you to the linked Forbes article for that verbiage).

Leaving off voluntary medical procedures and things not covered by the system for now, If an individual can pay a private doctor out of pocket for a faster diagnosis and treatment, what the hell good is it to make other people wait for the same diagnosis and treatment? That’s not equal access to healthcare, that’s a two tiered system where wealthy people get RAPID and UNHURRIED healthcare and poor people get OVERWORKED and SLOW healthcare… or sometimes none at all if their medical problem kills them while they’re waiting for an appointment.

That’s not a single-payer system. That’s a government provided “healthcare of last resort” for people who can’t afford to pay for their own, particularly when private physicians often perform services that are supposed to be covered exclusively by the public system.

And if any given physician has the choice whether to perform government price-fixed procedures for the masses or higher value procedures for a select few out-of-pocket payers, it penalizes those doctors (through lower wages and higher patient volumes) who are doing it for the ethics… actually forcing them to provide a lower quality of service (slower) than they would perhaps be able to provide if they were private.

Good – Fast – Cheap : Pick One, Canada! Amirite?

[FrankOneParticipant 1417]

I think you have a two-tiered system in the US, too: If I’m wealthy I can go to the Cleveland Clinic, Mayo Clinic, etc, or the best hospital for a given ailment. I lived in a rural area for years; the nearest local hospital was deemed a death trap; my co-workers suggested I never go there. To those who can’t afford travel, it was their only option.

One aspect of health care that isn’t discussed is how the free-market system has been a driver for innovative drugs; America has led drug development. So we effectively subsidize development, by paying higher prices for medications in the US, than in other countries that negotiate lower prices for the same drugs, under single payer schemes. And foreign countries which allow domestic companies to produce generics of US drugs without paying.

While it is true that money is saved on administration of insurance claims and payments, by going to a single payer system, it affords a ‘one size fits all’ solution to patients. To hold costs down to a reasonable fraction of GDP, rationing is necessary — long waits for procedures, denying certain procedures. But, rationing also exists in private insurance — lifetime benefit caps are a perfect example. Then there are moral questions — should the UK National Health Service spend hundreds of thousands of dollars for procedures that only extend life, by, say, a year? Typically countries have boards to decide such questions.

There are also a lot of fraudulent medicare claims in my opinion.

Personally, I favor a COMPLETELY free market, where insurance is not tax free and provided by companies, where hospitals don’t need ‘certificates of need’ to open, and are required to post prices and truly compete with one another, and where nurses are empowered to perform more procedures and prescribe drugs. If more medical care was paid out-of-pocket, there would be more competition. Liability insurance / lawsuits are also out of hand in the US. So often more diagnostic testing is done than is justified.

A very interesting topic for discussion.

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