CANADIAN MOMS - What are your health care experiences?
Moms View Message Board: General Discussion: Archive October 2007:
CANADIAN MOMS - What are your health care experiences?
Note - this is not a debate. I am asking Canadian moms to answer questions about their experiences with the Canadian health care system. I am asking because Canada is the nearest country with a single-payer (government and tax-based rather than private health insurance paid by an employer or individual) system and I'd like to know how it compares with our experiences. I'm looking for facts based on personal experience and knowledge. If anyone wants to debate the merits of one health care system against another, please start a thread on the debate board.
Canadian Moms - here are some questions:
What province do you live in, and do you live in or near a big city or a rural area? If you live in a rural area, how far away is the nearest hospital? the nearest adult medical practice? the nearest pediatrician? the nearest dentist?
What percentage of your paycheck (income) is deducted to pay for healthcare insurance?
Who decides which primary care doctor, pediatrician, or dentist will treat you and your family?
If you want to see a specialist, who decides whether you should see a specialist and decides which specialist you see (or which group of specialists you can choose from)?
From the day you call, what is your average wait for an appointment with your primary adult care physician? gynecolotist? pediatrician? specialist? dentist?
Do you pay any co-pay fee for any of your medical visits?
If you think you have an emergency medical problem, who decides whether you go to a hospital emergency room?
Who pays for prescription medicines - you or the health care system?
Have you ever had any problems getting a prescription medicine your doctor prescribed (that is, it's not on the "covered" list)?
Who pays for eye exams and eyeglasses or contact lenses?
Have you or a member of your family ever had emergency surgery? How long did it take from the time the person fell ill until the surgery was performed?
Have you or a member of your family ever needed non-emergency surgery (for example, a hysterectomy)? If so, how long did it take from when the surgery was recommended until it was performed?
What about cancer treatments? chemotherapy, radiation therapy? Are they covered? Are there long waiting lists?
What about mental health care? Who decides if it is needed? Who decides which practitioner you see? What is the waiting period before treatment begins? Who decides when the treatment is terminated?
Is dental care covered (I am guessing it is)? Is any kind of dental care not covered (i.e., dentures, bridges, cosmetic caps)? Is there a co-pay for any kinds of dental treatment?
Are there medical treatments not covered by your health-care system? If so, what are they?
Do people also buy private health insurance to cover "gaps"? If so, what are the gaps covered? What is the average cost?
I believe that in England people can pay (through insurance or out of pocket) for private hospital rooms, to see particular doctors, and to select their own nursing home/rehab facility. Is that the case in Canada?
Ginny, I am SO glad you posted this! I have wondered the same thing, and now, I *really* am interested in this.
Come on you guys, give us the scoop!
Inquiring minds want to know! I'm very curious, too!
"What province do you live in, and do you live in or near a big city or a rural area? If you live in a rural area, how far away is the nearest hospital? the nearest adult medical practice? the nearest pediatrician? the nearest dentist?"
I live in Ontario, less than an hour outside of Toronto. We have a hospital 10 minutes from my house. I'm not sure what you mean by adult medical practice, but I'm assuming a family doctor. We have an overall shortage of family doctors, but do have several in our town. My kids all go to a family doctor in town, and hubby and I go to the one we've had for many years. She's less than an hour away. We could all go to the one in town, but we chose to stay with the one who knows our history. We used a pediatrician in the next town, which is 10 minutes away. Ditto the dentist. There are several dentists in our town, but we like this guy.
"What percentage of your paycheck (income) is deducted to pay for healthcare insurance?"
We don't have anything deducted. It's an extra benefit to have extra coverage, which we do have, but everyone is entitled to basic health care. It has nothing to do with our employers.
"ho decides which primary care doctor, pediatrician, or dentist will treat you and your family?"
We do.
"If you want to see a specialist, who decides whether you should see a specialist and decides which specialist you see (or which group of specialists you can choose from)?"
We decide together with our family doctor/pediatrician/dentist.
"From the day you call, what is your average wait for an appointment with your primary adult care physician? gynecolotist? pediatrician? specialist? dentist?"
If I call with something that requires immediate attention, I can normally get in the same day to see the doctor or dentist. I haven't used a gyne since Meg was born in 1995, so I'm not sure. If it's not urgent, it can take months to get in to see a specialist.
"Do you pay any co-pay fee for any of your medical visits?"
Not for normal medical care, but for some specialists we have to pay. I have never had to pay anyone yet.
"If you think you have an emergency medical problem, who decides whether you go to a hospital emergency room?"
I do. If I choose to go to the doc first, she will suggest it if she thinks it's necessary. She will then call ahead to let her know we're on our way.
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Seniors are covered, other than something like a $3 fee. My husband's work benefits cover most of ours, and we pay the rest. For people who have rare special needs, the government will cover the cost of some meds and even special food.
"Have you ever had any problems getting a prescription medicine your doctor prescribed (that is, it's not on the "covered" list)?"
A few things aren't covered on some plans, but ours is excellent.
"Who pays for eye exams and eyeglasses or contact lenses?"
Kids and seniors are covered for exams, but adults pay. Work benefits may or may not cover glasses or contacts. Ours does.
"Have you or a member of your family ever had emergency surgery? How long did it take from the time the person fell ill until the surgery was performed?"
I have a friend who had to have his gallbladder taken out last week, and it was done within a couple of days of the start of his symptoms. My mom had a mastectomy many years ago, and it was done within a week of her feeling a lump.
"Have you or a member of your family ever needed non-emergency surgery (for example, a hysterectomy)? If so, how long did it take from when the surgery was recommended until it was performed?"
My sister had a hysterectomy in the spring, and it took a couple of months. I think she chose the time she wanted it done, for work reasons. Sonja had hip surgery, and it was also a couple of months.
"What about cancer treatments? chemotherapy, radiation therapy? Are they covered? Are there long waiting lists?"
It's all covered, but there can be waiting lists. My father died before being formally diagnosed, although he was only sick for a short period of time. When my nephew was diagnosed with leukemia when he was 4, he was in The Hospital for Sick Children in Toronto the same day. That was many years ago. Medical wait times is one of the big issues in upcoming elections.
"What about mental health care? Who decides if it is needed? Who decides which practitioner you see? What is the waiting period before treatment begins? Who decides when the treatment is terminated?"
That's something that would be decided with the family doctor. The doc might suggest someone, or a few different doctors, and the choice is ultimately the family's. If it's an emergency, the person would typically be put in the hospital for observation. I know that some people deal with nightmares with this issue, but I'm not sure if it's a professional thing or just the nature of the problem their dealing with. I've never dealt with it first hand. Oh, I do have a family member who went through some severe depression a couple of years ago. She went to a treatment facility for 2 summers, received excellent care, and came out 100% better. She didn't have to pay anything, because her doctor sent her. People who check themselves in do pay. She had to wait a bit to get in, but I don't think it was terribly long time.
"Is dental care covered (I am guessing it is)? Is any kind of dental care not covered (i.e., dentures, bridges, cosmetic caps)? Is there a co-pay for any kinds of dental treatment?"
No, dental care isn't covered by the government, but most employers pay at least a portion of it.
"Are there medical treatments not covered by your health-care system? If so, what are they?"
Some specialists, ie foot specialists, and cosmetic surgery unless it's needed for medical reasons. We do have to pay for a couple of the adult vaccines, but the health unit will normally give them for free. Our drug plan covers them anyway. There could be more, but I haven't come across them.
"Do people also buy private health insurance to cover "gaps"? If so, what are the gaps covered? What is the average cost?"
People might buy insurance if they don't have any benefits at work. I have no idea about cost.
"I believe that in England people can pay (through insurance or out of pocket) for private hospital rooms, to see particular doctors, and to select their own nursing home/rehab facility. Is that the case in Canada?"
Our work benefits might cover private rooms, but we can also pay the hospital if we want to. We don't have to pay for certain docs, rehab or nursing homes. We can choose the ones we want, although we might have to deal with a waiting list.
I forgot to mention some important things to families like mine. If you have family members with special needs, you receive extra government funding. Assistance for Children with Severe Disabilities (ACSD), which becomes Ontario Disability Support Program (ODSP) when the child turns 18, covers many things. Because Kayla's dental issues were caused by her low muscle tone in her face, her braces are covered. We pay 50% of the cost of my other daughter's braces, and hubby's work covers the other 50%. We have never had to pay for any of the therapies Kayla has received, and she's had speech, occupational and physical therapy, as well as swimming therapy. The mileage to and from all of these things is covered. I get funding to pay for a tutor for her. They would pay for extra laundry supplies, special clothing or shoes, special toys/equipment/learning aids. They pay for diapers for people with special needs once they turn 3, and increase the amount paid at 7. The cover family relief, which could even be a cleaning lady if I wanted to use it for that. It's really a great program, but we just use if for the necessary stuff. After reviewing family income and expenses, and amount is agreed upon and direct deposited at the end of each month.
Assisstive Devices Program (ADP) covers 75% of the cost of specialized equipment - wheelchairs, scooters, leg/foot braces, prosthetics (including mastectomy prosthetics), specialized feeding supplies, etc. If the person also receives ACSD/ODSP, the extra 25% is covered.
Finally, we have Special Services at Home (SSAH), which will cover one to one workers for the child. That could be used as programming time or respite.
SSAH is paid monthly, when invoices are submitted, and the family pays the worker.
After all of this, we can still claim the individual on our income tax, and a pretty decent amount is written off for the disability benefit.
This all helps so much!
I want to move to Canada!
Very interesting information. 
Marcia, thank you. But let me ask, does any tax come out of your husband's paycheck to pay for healthcare benefits? For example, the deduction for Social Security (federal retirement benefit) is 6.2% and for Medicare (medical care for senior citizens) is 1.45%, totaling 7.65 percent. My employer is required to pay an amount matching these deductions, for a total of 15.3% of payroll. Self employed persons are required to pay the whole 15.3%. I know Canadian healthcare is tax supported, and I thought it was a payroll deduction or earned income tax.
//What province do you live in, and do you live in or near a big city or a rural area?//
Nova Scotia. I'm in a semi-rural area but it's only about 35-45 minutes from Halifax
//If you live in a rural area, how far away is the nearest hospital?//
About 35 minutes.
// the nearest adult medical practice?//
15 minutes down the road - this is my family doctor.
// the nearest pediatrician?//
Probably 35-45 minutes.
//the nearest dentist?//
5 minutes up the road.
//What percentage of your paycheck (income) is deducted to pay for healthcare insurance?//
4.7% That's our private insurance. I don't know what portion of our taxes go to medicare.
//Who decides which primary care doctor, pediatrician, or dentist will treat you and your family?//
I do.
//If you want to see a specialist, who decides whether you should see a specialist and decides which specialist you see (or which group of specialists you can choose from)?//
The only specialist I've seen was my ob/gyn when I was pregnant. My doctor let me know she doesn't deliver babies and asked if there were any ob/gyn's I'd heard good things about and would like to go to. I gave her a name and she refered me.
//From the day you call, what is your average wait for an appointment with your primary adult care physician?//
I have an appointment every 3 months (for my depo-provera shot) but when I've needed to go in quickly it's been fairly fast, depending on seriousness. When I had a breast infection it ws a few hours. With matters that are serious but not urgent I generally get in the next day.
// gynecolotist? pediatrician? specialist? //
My family doctor fills most of those roles. She does my papsmear, checks the kids, etc. An old fashioned general or family physician.
//dentist?//
When I had a painful tooth that needed a root canal it was within a few days. They're generally harder to get in to than the doctor but it should be noted that for adults, they are not covered by medicare. We pay for their services through insurance and out of pocket.
The absolute worst wait was a year to get my sons decayed molars pulled. Part of that delay was a clerical error but most of it was simply a horrible backup in the system. Pediatric dentistry IS covered under medicare.
//Do you pay any co-pay fee for any of your medical visits?//
For the doctor, nothing. For the dentist (which again isn't covered by medicare and is private, I pay what insurance doesn't)
//If you think you have an emergency medical problem, who decides whether you go to a hospital emergency room?//
I do.
//Who pays for prescription medicines - you or the health care system?//
Insurance and myself.
It needs to noted that the drugs are bought by the provinces so they do negotiate large discounts since they buy in such bulk. So although medicare doesn't pay for my prescription (though it's different with kids and senoirs I believe) I do benefit hugely from the reduced prices.
//Have you ever had any problems getting a prescription medicine your doctor prescribed (that is, it's not on the "covered" list)?//
No.
//Who pays for eye exams and eyeglasses or contact lenses?//
Medicare, I think, one visit a year for the kids but in excess of that and in the case of glasses and in the case of adults, it's private insurance and out of pocket.
//Have you or a member of your family ever had emergency surgery? How long did it take from the time the person fell ill until the surgery was performed?//
My mom. It was her gall bladder. She went into the hospital in the morning and by the afternoon had had the operation.
//Have you or a member of your family ever needed non-emergency surgery (for example, a hysterectomy)? If so, how long did it take from when the surgery was recommended until it was performed?//
No.
//What about cancer treatments? chemotherapy, radiation therapy?//
My dad had Prostate cancer. Diagnosed at the end of last October, an operation in January and follow up visits in early spring indicated that he should have radiation as well and that was over by the end of June I think. He's cancer free now.
// Are they covered? Are there long waiting lists?//
Everything was covered except for anti-biotics for a bladder infection I think...No, even a good portion of that because he's a senior. i think the waiting list was about 6 weeks?
//What about mental health care? Who decides if it is needed? Who decides which practitioner you see? What is the waiting period before treatment begins? Who decides when the treatment is terminated?//
I have no idea. I have heard that mental health care in our province is abysmal. but I have neither analogies nor data to back that up.
//Is dental care covered (I am guessing it is)?//
No. That and eyewear are what we really have our private insurance for. Children are covered for one visit a year until 12 or 14 and a portion of their dental work is as well I think.
// Is any kind of dental care not covered (i.e., dentures, bridges, cosmetic caps)? Is there a co-pay for any kinds of dental treatment?//
None of that is covered.
//Are there medical treatments not covered by your health-care system? If so, what are they?//
Dental, eye exams...wart removal. However, this stuff can be claimed whe you're doing up your taxes so you might get a bit back.
//Do people also buy private health insurance to cover "gaps"? If so, what are the gaps covered? What is the average cost? //
Yes, we get it through my husband's work.
The gaps are dental care, eye care and prescriptions.
$80 a month for our family.
//I believe that in England people can pay (through insurance or out of pocket) for private hospital rooms, to see particular doctors, and to select their own nursing home/rehab facility. Is that the case in Canada?//
My only experience was when I gave birth to my kids. When I had my first we had no private insurance so we took the options that cost us nothing. That meant a ward room when I was in recovery - a room with 3 other new moms. With my son we opted for a private room and our private insurance covered the difference.
I have to say though that in both instances we got a private birthing room with bath, rocking and easy chair and cable TV.
I shoud mention that whenever I mention private insurance I mean it's through my husband's employer.
//But let me ask, does any tax come out of your husband's paycheck to pay for healthcare benefits...//
It's not a specific deduction. It's part of our income tax and comes out of the pool in the same way defense spending does.
I have a question to throw into the mix. What about therapy (speech, OT, PT) for adults and children? Is it covered by the national coverage or a separate policy? Are there limits to how much therapy (per week and overall) can be received? Are there certain diagnoses that don't qualify? Can you pick your provider? Can you receive tx at school and privately simultaneously? How long is the wait?
We were very fortunate when it came to therapy for Kayla, for a couple of reasons. When she was in foster care, she had services from 7-17 months. She came to us at that time. Because I knew an amazing pediatric PT at our local hospital, I was able to get her in for PT and pool therapy immediately. We did have to wait for speech, but not for a crazy amount of time. I can't remember exactly. Ditto OT. I could have opted to pay a private therapist myself, and the ACSD funding would have covered just the assessment visit each year. (from what I remember) I chose to wait, because I've done enough therapy with kids that I was doing everything at home anyway.
When the kids are small, the therapies typically come from a hospital environment, but they might do the visits in the home or nursery school instead of the clinic. We had PT at the hospital, and the other 2 went to the preschool most of the time.
Once they get to school age, they are handed over to Community Care Access Centres (CCAC), or other treatment centres. There would be one therapist for each area, so that would cover several schools or small towns. We don't get to choose which therapist, as each one visits several kids at each school. They receive treatment in blocks. For speech, I think Kayla got 12 week blocks, and she would have one on, one off. Again, I'm pretty sure that's what it was, but it was quite a while ago. Her OT and PT were ongoing, until the time the therapists and I decided she didn't need it. If I wanted her to have more services, they would come in for an assessment and then start her again. She might get the assessment fairly quickly, but would probably have to wait, unless it was something pretty urgent. Depending on the diagnosis or the needs of the child, the therapy could be ongoing for years. Sonja started all therapies as a child, and had them until she died at 21. Chrissy is 13, and has also had services all of her life. Both girls use wheelchairs, standers, walkers, need total care and are non verbal. They didn't get a lot of speech therapy, but there wasn't a lot we could do. We did some augmentative, but it was and is pretty basic.
Oh, there is another kind of speech therapy at the school level, but as far as I'm concerned, it's pretty useless. They hire one of the special ed people as the speech person, and that person covers either a part of or the whole board of ed. They see the kids once in a while, leave some suggestions, and hopefully the teachers or a volunteer will follow through. I volunteered the first year I had a child in the school. I'm so glad that Kayla qualified for CCAC help, and a real therapist! The board "therapist" just deals with articulation, I believe, but Kayla need help in all areas of speech.
As adults, hospital clinic or CCAC therapy is still free. My dad went to the hospital for OT for arthritis. They have pool therapy for adults with all different needs. As I mentioned, Sonja continued to receive therapy, and would have no matter how long she lived.
My guess is that I could have paid a private therapist at the same time. If they were both free I wouldn't be able to duplicate services, but private I would have to pay for.
As far as diagnoses, it seems to be more needs based. Kayla is 11, and just last year received the official diagnosis of mild developmental delay. She received all therapies based on her needs and the assessments of the therapists and myself. Because of the official diagnosis, I will no longer have to apply yearly for a tax credit, but she will have to re-apply when she turns 18. It will still go through without question, because that diagnosis will never change.
The "foster" funds sound fairly similar, as far as full coverage of care. It is the same here in the States. The children with special needs are covered under Federal IV-E Foster/Adoption Assistance until the age of 18 then they roll over to SSI/SSD if they are adopted and their parent qualifies for them to receive funds. They are fully covered under Medicaid for their entire lives and that includes all needs to modify/contribute to their quality of life. Wheel chairs, diapers, therapies, aids and such.
I think we (in the states) are fed nightmares of care in Canada so that way we will not push for universal care. But honestly, so far it doesn't sound much different then are care system here in the states.. The waiting periods sound no different then what we have here in the states.
Anyone else, please do share... This is a major issue here and we could use all the information we can get.
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