Canadian Health Care Issues

[lets-retire]

In network provider, not a ton of options otherwise, and from a medical standpoint I think the doc is highly qualified and has a good patient rapport. The waiting, phone tag, etc is a common occurrence at many local providers apparently.

You see, the doc makes nothing from my phone calls but gets paid a little bit when I have to go in and see him for a couple of minutes. Probably a symptom of my health insurance coverage and the payment structure more than poorly run administration at the docs office. From a doc's standpoint of practice management - focusing on revenue producing activities (patient visits) to the detriment of phone based medicine that is uncompensated is probably a smart thing to do in what is I'm sure a fairly small margin business.

We haven't had near the troubles you have detailed. When we did get involved with doctors who were more interested in only the money making side of their business we took our insurance money and went to another doctor. The DWs first neurologist was more concerned with her research than providing patient care, so when the DW would call to be seen about an issue, it would take 2-3 months to get in. We would go, the doc would tell us that we should have come in sooner because she couldn't do anything now, DW would explain that she called when she was having the issue and asked for the first appointment and this was it. After several months of this the DW changed neurologists. The new one started great then started sliding. The DW complained that the phones weren't being answered and calls weren't being returned. Apparently several patients were complaining about the same thing, because the counter help was fired and service went back to normal.

With those two exceptions I have seen doctors in four states using private insurance in areas ranging from large cities to small very rural towns. If I need anything refilled or assistance in any way, I have been able to pick up the phone and get it.

 

[FUEGO]

We haven't had near the troubles you have detailed. When we did get involved with doctors who were more interested in only the money making side of their business we took our insurance money and went to another doctor. The DWs first neurologist was more concerned with her research than providing patient care, so when the DW would call to be seen about an issue, it would take 2-3 months to get in. We would go, the doc would tell us that we should have come in sooner because she couldn't do anything now, DW would explain that she called when she was having the issue and asked for the first appointment and this was it. After several months of this the DW changed neurologists. The new one started great then started sliding. The DW complained that the phones weren't being answered and calls weren't being returned. Apparently several patients were complaining about the same thing, because the counter help was fired and service went back to normal.

With those two exceptions I have seen doctors in four states using private insurance in areas ranging from large cities to small very rural towns. If I need anything refilled or assistance in any way, I have been able to pick up the phone and get it.

I'm strongly considering switching doctors. The last straw may have been yesterday. They have H1N1 shots available now. All 4 of us are existing patients (having been seen previously at this office). So I get myself and the two kids signed up for h1n1 shots - simple nurse visit, in out done, they are going to get paid by the insurance company $10 per shot to administer each shot (versus $21.50 per shot to administer a regular flu shot!!??). I pay nothing out of pocket because the ins co picks up the tab for immunizations like this. Nota bene - the h1n1 shot is provided to health care providers free from the govt, but they can request payment just to administer it to patients.

Here's the zinger - they refuse to allow a nurse to administer the h1n1 for my wife because she was last seen 2 years ago. They want her to schedule a regular doctor's visit to get the shot. Not only will this consist of 15-45 minutes of waiting in the main waiting room then another 15-45 minutes in the little exam room, but since we have the high deductible ins plan, it will cost us $60-110 out of pocket for a regular visit. I'm not aware that a healthy 32 year old female who has not needed to go to the doctor for 2 years (other than the annual lady dr visit) would need to see an md just to get an h1n1 shot. Methinks this is an attempt at strictly "revenue enhancement". No way is she going to waste an extra hour+ waiting to see a dr and then pay $60-110 out of pocket for the h1n1 shot. Any medical opinions from dr's, nurses, etc?

 

[Kroeran]

sometimes what seems like a pain in the butt is the universe doing you a favour

Personally, I would be too superticious to not do the check up.

 

[FUEGO]

sometimes what seems like a pain in the butt is the universe doing you a favour

Personally, I would be too superticious to not do the check up.

This will be one of those "anything changed since your last confession?" type visits. Then the doc says, great, keep up the good work, exercise, eat right, you're doing good. 2 minutes max, then an h1n1 shot, then out the door. I'm pretty sure this is 100% a revenue enhancing office visit required to get a minimum profit level from the DW. What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.

DW has been going to her lady dr visit annually so she's doing the regular screenings.

One thing I find interesting is that if this were a matter of paying the $10-25 copay with "regular" insurance, we might just pay it. But with the high deductible "consumer focused" plan, we are intentionally cutting costs here since it is our money and barring an emergency in the next 14 days, we will come no where near the $2400 deductible to cost share w/ the ins co.

 

[Trek]

What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.

Maybe it's because I lived in Florida which is full of old sick people, but in my experience a doctors office couldn't care less if you moved on. Plenty of other suckers to take your place that will just do as their told and not rock the boat.

 

[FUEGO]

Maybe it's because I lived in Florida which is full of old sick people, but in my experience a doctors office couldn't care less if you moved on. Plenty of other suckers to take your place that will just do as their told and not rock the boat.

You're probably right. Since we are all young and (relatively) healthy, I imagine we are low margin customers. This is definitely a commodity business as best I can tell. And most of the customers I see waiting in the waiting room are older people who probably are in the doc's office 10-100x what anyone in our family is.

 

[Kroeran]

This will be one of those "anything changed since your last confession?" type visits. Then the doc says, great, keep up the good work, exercise, eat right, you're doing good. 2 minutes max, then an h1n1 shot, then out the door. I'm pretty sure this is 100% a revenue enhancing office visit required to get a minimum profit level from the DW. What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.

DW has been going to her lady dr visit annually so she's doing the regular screenings.

One thing I find interesting is that if this were a matter of paying the $10-25 copay with "regular" insurance, we might just pay it. But with the high deductible "consumer focused" plan, we are intentionally cutting costs here since it is our money and barring an emergency in the next 14 days, we will come no where near the $2400 deductible to cost share w/ the ins co.

yeah...I see what you mean. Our Veteranarian is doing that on us with prescription refills

why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?

 

[FUEGO]

yeah...I see what you mean. Our Veteranarian is doing that on us with prescription refills

why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?

We're all going in tomorrow morning. DW is coming with me to help [-]restrain [/-] comfort the children while they receive their shots. We will see if they relent on DW getting a shot from the nurse. I'm definitely going to confront them as to whether the issue is medical in nature or financial. I may even offer them a crisp $20 in exchange for immediate service for the DW.

 

[Rustic23]

Trek,
If what they say is right, 'Medicare does not cover the doctor's cost and cost are made up by other patients', then my guess your doctor may care, unless you are on Medicare.

 

[FUEGO]

Trek,
If what they say is right, 'Medicare does not cover the doctor's cost and cost are made up by other patients', then my guess your doctor may care, unless you are on Medicare.

It seems like a billing-savvy doctor could make up the losses on revenue. Ie - the 2 minute dr's visit to refill an rx that nets him $40. Or a whole ton of unnecessary lab tests?? Not sure where the profit is in medicare/medicaid reimbursements, but if there are some things that pay more than others, I'd bet a savvy/unscrupulous dr could figure out how to work the system to get a little "juice" out of it.

 

[Buckeye]

People can get flu shots at Walgreens just walking in off the street. Why is your doc so concerned about not seeing your wife for 2 years? The folks administering the shots at Walgreens know nothing about your health history and they are not concerned. Of course, they have no revenue enhancement opportunities related to an office call.

 

[Gone4Good]

I agree with you 100%

I don't think it's technically accurate to say health care in the US is "rationed" any more than it is correct to say that we ration food or houses. There's a market. It's a dysfunctional, inefficient market, but it does exist.

But it is rationed. That's what markets do. They set a price that buyers and sellers agree is fair, but if you can't afford that price, tough luck. So if you can't afford medicine and go with out (as many people do), medicine is being rationed. Sure, no government agency is saying "you can't have that". But the seller sure is.

The only difference between administrative rationing and market based rationing is that in market based rationing the well-to-do can pretend it doesn't exist while in administrative rationing they have to wait in line with everyone else.

 

[Meadbh]

Exactly. Why is Mrs Fuego not getting her H1N1 shot? Because it's rationed.

"Rationing is the controlled distribution of scarce resources, goods, or services." (Wikipedia)

 

[samclem]

But it is rationed. That's what markets do.

I guess we'll just have to disagree on the definition of "rationing." You've certainly chosen to use the word in a way outside of normal experience. No one says "I didn't buy the sirloin at the market because it was being rationed." They say "the price was too high." And we know what that means. Here are some other ways rationing is different from the market.
- When prices go up, we can expect that higher supplies wil soon follow (as suppliers respond to the higher prices). This tremendously beneficial mechanism does not exist with administrative rationing-what is in short supply (doctors, medicines, etc) tends to remain in short supply.
- People can optimize their consumption and make judgments on worth. If I want the sirloin I can have it by choosing to economize somewhere else. If a 42 YO woman with a family history of breast cancer wants a mammogram she can get one and choose not to buy a new dress. Under administrative rationing, if the guidelines say a 42 YO woman doesn't need a mammogram, then she's SOL.

 

[eridanus]

- People can optimize their consumption and make judgments on worth. If I want the sirloin I can have it by choosing to economize somewhere else. If a 42 YO woman with a family history of breast cancer wants a mammogram she can get one and choose not to buy a new dress. Under administrative rationing, if the guidelines say a 42 YO woman doesn't need a mammogram, then she's SOL.

And if she does have cancer, she can forego another dress and get her cancer treated.

 

[youbet]

We're all going in tomorrow morning. DW is coming with me to help [-]restrain [/-] comfort the children while they receive their shots. We will see if they relent on DW getting a shot from the nurse. I'm definitely going to confront them as to whether the issue is medical in nature or financial. I may even offer them a crisp $20 in exchange for immediate service for the DW.

Your logic for insisting that you go out of your way to have your shots in the Dr office escapes me. Why not simply stop at one of the Walgreens or CVS stores you'll pass along the way and get the shots there?

Our doc (for the past 28 yrs) offered regular flu shots at his office but is not offering H1N1 shots unless you have reason for concern and insist on a consultation regarding them vs your personal health situation. I'm guessing he doesn't want to assume the implied responsibility that since you're in your own doc's office for the shot, doc or his staff is reviewing your file to assure the shot is right for you.......for no charge.

DW and I are heading over to CVS for the shots right now. They charge a $15 "administrative" fee and you fill out and sign a form indicating you know what you're doing and have read and understood the information CVS provided you regarding risks involved.

If you're happy with your doc and his/her practice other than this issue, why not go and get the shots in a more appropriate setting (you're saying you DON'T want doc involved, just the nurse) like a retail pharmacy or quickie clinic?

 

[Gone4Good]

- When prices go up, we can expect that higher supplies wil soon follow (as suppliers respond to the higher prices). This tremendously beneficial mechanism does not exist with administrative rationing-what is in short supply (doctors, medicines, etc) tends to remain in short supply.

Yes, but the other side of that equation is that demand is pushed down as people get priced out of the market. Which is perfectly fine when we're talking about sirloin and dresses, but it's something entirely different with health care.

The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.

 

[youbet]

why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?

The middle ground, as indicated in my post above, is to take the flu shot business elsewhere but decide whether to change family docs based on overall performance of doc and his office. Flu shots, for people like the Fuego family who difinitely don't want a doc overview, are more appropriately done in a mass clinic setting.

If the Fuego family is unhappy with this doc and his/her staff, including but not limited to this flu shot situation, they should simply establish a relationship with another doc or practice. But moving based only on doc's office not competing well with Walgreens and CVS for flu shots would be silly. Doc's office isn't the best place to get the shots given Fuego's criteria of fast, cheap, no overview.

 

[youbet]

The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.

A good place to see rationing in action is American specialty clinics where wealthy Canadians compete with American citizens for places in line.

 

[samclem]

The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.

The argument usually comes to this. But the demand curve for the insurance which would pay for a heart transplant is not vertical. Many people can afford it, and do. There are all kinds of catastrophic events for which we buy insurance.

 

[FUEGO]

Your logic for insisting that you go out of your way to have your shots in the Dr office escapes me. Why not simply stop at one of the Walgreens or CVS stores you'll pass along the way and get the shots there?

I'm guessing he doesn't want to assume the implied responsibility that since you're in your own doc's office for the shot, doc or his staff is reviewing your file to assure the shot is right for you.......for no charge.

DW and I are heading over to CVS for the shots right now. They charge a $15 "administrative" fee and you fill out and sign a form indicating you know what you're doing and have read and understood the information CVS provided you regarding risks involved.

If you're happy with your doc and his/her practice other than this issue, why not go and get the shots in a more appropriate setting (you're saying you DON'T want doc involved, just the nurse) like a retail pharmacy or quickie clinic?

I never said he should give us the shot for no charge. They charge an administrative fee that retails at $21 or so, and my insurance pays them $10. The h1n1 vaccine itself is free. $10 for a nurse-administered shot seems pretty fair given that a simple sick visit with an actual doctor plus nurse only costs us $60 or so typically (insurance negotiated rate, out of pocket of course).

As I said, the doc didn't need to review any of our charts for the other 3 members of the family. I don't think their insistence on a full doctor visit for DW had anything to do with medical purposes. Strictly financial - they wanted to make $60 from her. They don't have any real medical tort liability since they are protected by a federal law that provides immunity to tort claims arising from administration of the h1n1 vaccine.

In this case, it wouldn't have taken more than 2 extra minutes to administer the shot to DW after the other 3 of us got the shot.

And I don't necessarily know if a quick clinic visit would be covered by our insurance. The public clinics were free, but had long wait times for a while. Not sure what the wait is like now. I guess we're down to the canadian system now - wait in line for a while, or pay a premium for quick service.

I guess our Family Practitioner doc is our Primary Care Physician except when it comes to things like immunizations sometimes. It just seemed logical to expect our Primary Care Physician to administer annual regular vaccinations to members of our family who are existing patients. I wouldn't run to the public health clinic or CVS if I needed a booster shot for tetanus or some other vaccine. I don't take my kids to the public health clinic or CVS for simple DPT or MMR vaccines although the administrative burdens are similar.

 

[Gone4Good]

The argument usually comes to this. But the demand curve for the insurance which would pay for a heart transplant is not vertical. Many people can afford it, and do. There are all kinds of catastrophic events for which we buy insurance.

So the answer to a broken health insurance system that excludes people with pre-existing conditions (like heart disease, for example) and forces more and more people each year into the ranks of the uninsured is for people to buy health insurance?

 

[eridanus]

YTG beat me to to it

 

[youbet]

I never said he should give us the shot for no charge.

And I didn't say that you did. I've been reading your posts a long time and, based on those, I'd never expect you'd make medical choices for your family based on a couple of bux one way or the other.

And I don't necessarily know if a quick clinic visit would be covered by our insurance.

They commonly are but you need to check with your provider, especially if you're in a PPO plan. DW and I are each with a different insurer, one through private and one through public employment, and they do cover quick clinics.

The public clinics were free, but had long wait times for a while. Not sure what the wait is like now. I guess we're down to the canadian system now - wait in line for a while, or pay a premium for quick service.

And just wait for what the future brings!

I guess our Family Practitioner doc is our Primary Care Physician except when it comes to things like immunizations sometimes. It just seemed logical to expect our Primary Care Physician to administer annual regular vaccinations to members of our family who are existing patients.

I guess we didn't look at the H1N1 "pandemic" (name per the current administration) and the resulting vaccination as an "annual regular vaccination." This seemed to be something under the control of the public sector.

We got our H1N1 shots at a local CVS Minute Clinic this afternoon. No issues. No dissatisfaction with our family doc for deciding not to provide these but rather directing us to use either the county health department or one of these clinics.

You've expressed a great deal of dissatisfaction with your family doc. I'd think you owe it to your family to go out and find one you prefer. Health issues can pop up without warning and needing to depend on a doc and staff you dislike and have lost confidence in would be a bad thing. There may come a time when we have less choice about selecting docs, but for now your doc is your doc because that is your choice.

 

[samclem]

So the answer to a broken health insurance system that excludes people with pre-existing conditions (like heart disease, for example) and forces more and more people each year into the ranks of the uninsured is for people to buy health insurance?

I don't think it's a simple problem, and I know you don't either. I'm fairly sure that oversimplifying the problem will not lead us to either a solution or to greater understanding of the problem. So, let's not do that.

Yes, I think insurance can play an important role in helping people pay for unexpected medical expenses, just as it plays a role in helping them pay for non-medical unexpected expenses. And, while I personally would like to see a different answer, I believe (based on what our present society demands) that the most constructive, least damaging role our government can play is to:
1) Require that individuals buy insurance (eliminating adverse selection)
2) Provide the outlines for the minimum standard required policy. It would provide "free" preventative care, meaningful co-pays, and no lifetime cap. No-frills care: no private rooms in the hospital, etc.
3) Establish rules that insurers must take all comers without underwriting and charge them all same rate for the standard policy..
4) Provide additional outlines for standardized optional supplemental policies (to foster efficient price competition in these policies).
5) Allow cross-state competition
6) Provide a clearinghouse for medical cost information and objective measures of medical care quality to better inform consumers
7) Provide subsidies to pay for medical insurance and care. But before any American is forced to pay for the care of another, the recipient must have spent a substantial portion of either their annual income or total assets on their own care.

Market based and without rationing. And get everyone used to the fact that good medical care costs money, and that, like food and shelter, they are responsible for providing for themselves unless they truly can't.

Sometimes I think the folks most afraid of the government takeover of
US medical care are Canadians. Hopefully they and US citizens will still have some place to go to get timely quality care in the future.