Many of you have probably at one point in time heard me raving about the greatness Canada's universal health care system and how excited I was to finally to be eligible to partake in it. I've been eligible for benefits for about a year and a half now, and although I'm extremely grateful to be covered at all, I have unsurprisingly discovered that the system has its own unique set of problems. But what exactly is covered under Canada's publicly-funded health care system, and what is the quality of care? I can only attest to my personal experience with the system in British Columbia (the system varies from province to province) as well as provide some info by doing some very basic research, but hopefully my experience will at least shed a bit of light on the subject and answer some questions I'm frequently asked by others.
Before I get into this, I'd just like to say that this topic is a BEAST, and it has taken me a really long time to get a decent understanding of it, so I apologize in advance for any inaccuracies or incomplete information.
Is Canadian health care free?
Canada's public health care, formally named the Medical Services Plan or MSP, is mostly free. There are no deductibles on basic care, and co-pays are virtually non-existent (Jeff had never even heard of a co-pay until I came into his life); however, coverage is paid for by income taxes, and, depending on a household's level of income and family size, British Columbia charges a fixed monthly premium and apparently is the only province in Canada to do so (lucky us). As a family of two, Jeff and I pay a premium of $109 a month, which covers both of us. For lower income families, premium assistance is available, which can cover anywhere between 20 to 100% of the premium depending on net income. Households with a yearly income of less than $22,000 are eligible for 100% premium assistance.
Does the MSP cover all health care costs for everyone?
No, but each legal resident of Canada receives the same level of basic essential care under the MSP. To my understanding, basic essential care means trips to the general practitioner (GP), the emergency room, certain specialists, having babies, many different types of surgery, etc. Jeff broke his collar bone a few years ago and, having no deductible or co-pay to worry about, paid all of 100 bucks to get 'er fixed (the 100 bucks was apparently for something non-essential--I can't recall what). It's pretty surreal for me to just go to my GP or a walk-in clinic (kind of like an urgent care center in the States) and not have to pay anything or fill out any or very little paperwork. Upon my first visit, they simply swipe or record the info from my CareCard, a card that all eligible benefit recipients receive in BC (and possibly elsewhere).
Depending on province, the MSP may not cover dental, vision, pharmaceutical medications except for the elderly and certain lower income families. Because of our level of income and as BC residents, Jeff and I do not get dental, medical or prescription coverage; however, these things are covered under Jeff's employment-based private insurance. Many employers offer insurance benefits through private firms, and these benefits vary from employer to employer. Jeff's particular plan, called a "spending plan", grants our household a few grand a year to spend on virtually any sort of medical costs: vision, dental, prescriptions, physical therapy, acupuncture, counseling, elective surgeries (even boob jobs--no joke), and much more. We submit all of our receipts to the insurance company, the insurance company sends Jeff's employer a bill, and his employer sends Jeff a check for reimbursement. It's common for the employer to increase the amount of money they will pay per year as part of a raise, and if the employee happens to go over their fixed amount, the employer can elect to pay the extra amount. If I get a job with a similar "spending plan", the fixed amount my company offers will add to our household's overall amount of coverage for non-essential items, meaning Jeff and I will both be covered under both spending plans.
For those who do not have employer-based insurance, there are certain programs for which Canadian residents can apply for assistance in paying for non-essential health care costs.
What is the quality of medical care in Canada?
I think it varies from doctor to doctor, practice to practice, and what type of treatment one is receiving. One fundamental flaw is the way doctor's offices get paid by the government for services rendered. I'm not sure about other provinces, but in BC, the government sets this blanket assumption that each patient will take a GP 15 minutes to treat and will therefore pay the doctor for 15 minutes of billing time for each patient. Appallingly, if the GP sees four different patients in a 15 minute span, the government will pay the doctor for an entire hour of billing time, and will end up paying amounts that exceed the amount of time possible for a doctor to treat patients in a given day. This obviously means that most doctors try to get people in and out the door as quickly as humanly possible, and I find this to be a problem of epic proportions. Since I've been here, I have seen GPs several times, both at my own family doctor and a walk-in clinic, and I would say about 90% of the time the doctor rushes through the visit at the speed of light and is very quick to simply whip out the prescription pad and shove me out the door. On one occasion I went to the urgent care center to get a second opinion on a diagnosis from my family doctor, and even though I was only there for a consult, the guy whipped out his prescription pad within literally 10 seconds of seeing me and started filling it out. I was like, dude, what the hell are you doing? I have found that you have to really prepare what you want to tell them in advance as they're really quick to cut you off or treat you with partial information, and I often leave there feeling like there was little to no point in me even going.
Not all doctors here are like this, however, and I have received some really excellent treatment from some. Also, there are other services provided by the system that seem superior to similar services in the US. For example, in BC, if you need blood tests, ECGs or a plethora of other tests, they send you to a lab that is separate from any doctor's office or hospital and full of expert phlebotomists and lab techs that are super efficient and effective. I have been to such labs on a number of occasions, and even though they're typically packed full of people each time I go, the wait time has been minimal as they have a huge staff that seems to really know what they're doing. When having blood drawn at doctors offices in the US, I can recall a number of times when the medical assistant has taken FOREVER to find a vein, sometimes fishing for it with the needle, resulting in a lot of pain and bruising, whereas I have never had to undergo this torture in Canada. My dentist and almost all the specialists I have seen have also been exceptionally good, and much to my mother's delight, I still have no cavities at age 29. :-P
How long do you wait to see a doctor in Canada?
There is a popular conception that Canadians wait eons for medical treatment, but I have found this to be only sometimes true. In fact, there have been many occasions in which I have received treatment quicker at certain times and for certain ailments than I have in the US. Also, at least in BC I have found that there are more urgent care type facilities than there are in the US and their hours are longer on average. Sometimes you do have to wait a while to see a doctor, but I can recall several occasions when I've sat in a US doctors office staring at posters of the circulatory system for hours and hours. The emergency room is no different--sometimes you get in quickly, sometimes you don't, and this is true of both countries.
Nonetheless, I can't say that I haven't had to wait 2-3 months to see a specialist out-of-town for certain conditions, and I can't deny the fact that I've had to schedule appointments for prescription refills with my family doctor 2-3 weeks in advance as she won't phone them in (which is typical) and has more patients than she can efficiently handle. During my uninsured days in the US, I've also had to wait 2-3 months to see publicly-funded specialists or pay hundreds of dollars to see privately-funded ones that I sometimes also had to wait for. Life-threatening conditions are treated immediately, but if you can wait, you're probably gonna. One day I was sitting in my family doctor's office and overheard the receptionist phoning a patient regarding a referral to a cardiologist. The receptionist said the next available appointment for a new patient was three months out. I almost fell off my f-ing chair. THREE MONTHS TO SEE SOMEONE FOR A HEART CONDITION! It must not have been life-threatening, but it's your heart! You need that, man!
It also took me FOREVER to find a family doctor in the area that was taking new patients, and I found that those who are are typically new to the profession and therefore less experienced. This is not to say that new doctors can't be good doctors or that all experienced doctors are good doctors, but I think you understand what I mean.
One thing that I think is a big problem here though is the shortage of costly diagnostic equipment. For example, MRI scanning machines are pretty scarce here. According to an article in BC Living, Canada has one of the lowest rates of MRI scanning machines per capita in the entire developed world, with only 6 machines per million people, compared to 40 machines per million in Japan and 27 per million in the US. The typical waiting time to get a MSP-covered MRI in Canada is 12-18 months. One can get a near-immediate appointment at a private MRI clinic, but you're going to pay around $700 to $900 bucks for one scan if you can afford it (wait a minute, that sounds familiar...). MRI scanners have become essential diagnostic tools, but here they're treated like some sort of luxury item as they're so hard to come by.
If I marry a Canadian, do I automatically get health coverage?
This common perception is entirely untrue. I wasn't eligible for benefits until I went through the immigration process and achieved permanent residency, which was eight months after Jeff and I got married. You must be a legal resident and be physically present in Canada for a minimum of 6 months out of the year in order to be eligible for MSP coverage.
As the cost of care is typically lower in Canada than the US, there are many Americans who come to Canada and pay out-of-pocket for treatment and perscriptions. For example, before I was eligible for MSP benefits, we had to pay my medical costs out-of-pocket, and it cost only $50 for me to get treatment at an urgent care center in Canada, whereas under my previous US insurance I would have to pay a $50 co-pay at an urgent care center in the US. Without insurance, one visit to an urgent care center in the US would have easily cost a couple hundred bucks.
At Least We're Covered
Having spent a good portion of my adult life in the US without any heath coverage or paying large deductibles, I have come to really appreciate the coverage that comes with simply being a legal resident of Canada. True, the Canadian system has a plethora of problems and we pay a whack of taxes to fund it, but I would take this over being uninsured or under-insured (made that word up, heh) any day of the week. Can you fathom how long it took me to pay off a $4,000 bill that was incurred in the US while I was uninsured? Do you know how hard it is for someone fresh out of college to pay a $1,500 insurance deductible for one frickin' trip to the emergency room? It's frickin' hard. I'm just glad that I eventually had the money to pay them off--many aren't so lucky.
The quality and accessibility of care is definitely a huge concern, and Canadians should continue to pressure their government for improvement in these areas. Overall though, polls show that the majority of Canadian residents are generally happy with their health care system, and the average life expectancy is higher here than in the US. Additionally, Canadian taxes, although high, go towards more things than just medical costs that improve the quality of life here and ultimately improve the quality of public health and safety: amazing recreational facilities, parks, clean streets, etc. These places and services are so great and I feel like we can actually clearly see how our tax dollars are being spent and how we're benefiting from them, whereas in the US that wasn't quite as clear to me.
No matter how frustrated I get with the rushed treatment I often receive or the amount of time I have to wait for an appointment, I try to keep in mind how awful it was to live without insurance at all and remind myself that there are millions of people out there who would love to be in my shoes. There is so incredibly much that should be improved in this system, but at the end of the day, at least we're covered.
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