Canadian Health Care Issues

[Kroeran]

just thought I would tell of my recent experience

As we are all aware, health care, though "free" is being rationed, and getting care involves perseverance, playing the system, begging, intimidation, acting outside of the box

I had a bilateral variable mental neuropathy (numb chin) suddenly come on four years ago, and every year, the GP would say "dont worry about it"

this year, partly due to being encouraged by my dentist, partly due to facing FIRE decisions, I decided to push the issue with the GP and shoot for an MRI.

so I made fuss about it, and mentioned that it was interfering with my work (that seemed to be a button), and got the referral to the neurologist, two month wait.

once I got to him, (wearing my best suit) immediately got the MRI requisition, low priority, estimated wait, 6 months. He offered a private MRI for $500 in Quebec if I got fed up waiting. 2 tier care is alive and well.

so instead of waiting for someone to call me, I went to the MRI clinic, and started making polite enquiries, let them know they could call me 24-7 on 10 minutes notice (they run 24 hours), got a special phone number to call re stand by.

I had decided to pull the plug on the free MRI and go to Quebec, but thought I would give the standby phone number one shot. called the stand by guy...got a slot that very night...unheard of...4 am, no problem.

got it done, then after a 2 day pause, dropped by the neurologists office, just to check if they received the MRI....receptionist did some digging and found it, told me the MRI was clear, booked meeting with neurologist to discuss next steps that week.

With all health support workers along the way, maintained chatty friendly respectful demeanor - they have a lot of discretion on how much to help you.

I share this as an example of how to push the system.

 

[Alan]

Thanks for posting. It sounds a lot like England, where the waiting periods for non-critical MRI's, specialists etc are a zipcode lottery (some areas are much quicker than others). My BIL usually has his MRI's late in the evening (he's had a slow growing brain tumor for the last 6 or 7 years).

Is private insurance available in Canada? When I lived in England many companies provided health insurance as part of your benefits so you could short cut the waiting lists for non-critical specialist care or elective surgery. (the 2 companies I worked for both provided health insurance).

 

[Kroeran]

the simple answer is that no, we have single-payer government-run, implemented by each province, enforced by the federal level.

effectively, this translates into the homeless getting the exact same healthcare as the 50 year old CEO of a large corporation, which is all very noble, but there are consequences when you communize a service.

some safety valves are going to Buffalo or other American cities for care, or crossing the provinicial border to Quebec, which is going a tad rogue at the moment, permitting private for cash MRIs.

of course, whenever someone famous or rich gets really sick, they go straight to the head of the line at some Boston teaching hospital.

the correct solution to the healthcare access issue is what my province had when I was a teenager...anyone with income below a certain threshold got their health insurance paid for. In this way, everyone gets healthcare, but you don't mess up the core system by communising it.

 

[Kroeran]

saw the neurologist and once he realised that this was not life threatening, pretty much lost interest in the issue, no curiosity whatsoever.

I made a few suggestions for approaches to take, and he said "would you like a script for that?"

the mayo in Florida is estimating 4k to diagnose the situation...wondering if I should do that.

 

[samclem]

This must be very frustrating. $4k sounds like a bitter pill, but if you've done enough research to make you think this might be something serious, it might be a good investment. Especially if you'll be in FL anyway for something else.

So, what happens when a Canadian goes somewhere else for a diagnosis--how does one get actual treatment? Do you have to go back to your family doctor or care gatekeeper clutching your MRI results and the doctor's finding and try to get someone to then take the problem seriously?

Good luck, I hope things work out.

 

[FUEGO]

Kroeran, this sounds like roughly the same effort it takes me to get a routine rx filled by my GP. Calls, waiting, phone tag, waiting, non-returned messages, etc. Of course I have top notch private health insurance here in the states so this isn't supposed to happen.

 

[youbet]

Kroeran, this sounds like roughly the same effort it takes me to get a routine rx filled by my GP. Calls, waiting, phone tag, waiting, non-returned messages, etc. Of course I have top notch private health insurance here in the states so this isn't supposed to happen.

I dont think your situation is related to your insurance. It would be the same if you were a cash customer. The problem is poorly run administration of the doc's office and your willingness to accept that.

 

[Alan]

saw the neurologist and once he realised that this was not life threatening, pretty much lost interest in the issue, no curiosity whatsoever.

I made a few suggestions for approaches to take, and he said "would you like a script for that?"

the mayo in Florida is estimating 4k to diagnose the situation...wondering if I should do that.

How very frustrating for you. If it were me, and it was something that really concerned me then I would want a second opinion and would be prepared to cough up the $4k.

 

[TromboneAl]

Is the point of the story that the Canadian system is a good one?

That is, the system discouraged further investigation of a problem which it didn't think warranted further expense, and at most didn't warrant immediate attention. When you pushed it through, it turned out that they were right.

Sorry to put it in a provocative way, but this story could be interpreted as showing how well it contains cost.

 

[Trek]

And $4K would be your monthly private health insurance premium in the US now that you have a pre-existing condition.

 

[Alan]

Is the point of the story that the Canadian system is a good one?

That is, the system discouraged further investigation of a problem which it didn't think warranted further expense, and at most didn't warrant immediate attention. When you pushed it through, it turned out that they were right.

Sorry to put it in a provocative way, but this story could be interpreted as showing how well it contains cost.

Al, you make a good point. Kroeran has now had 2 medical diagnoses - one from his GP and one from a specialist.

What I didn't realize is that the Canadian system doesn't allow paying for private consultations as he obviously doesn't fully believe what he is being told and wants more tests and opinions. In the USA and UK if you are prepared to come up with all the money then I expect you get as many consultations as you'd want or can afford to pay for.

 

[Kroeran]

Is the point of the story that the Canadian system is a good one?

That is, the system discouraged further investigation of a problem which it didn't think warranted further expense, and at most didn't warrant immediate attention. When you pushed it through, it turned out that they were right.

Sorry to put it in a provocative way, but this story could be interpreted as showing how well it contains cost.

the purpose of the posting was mainly as a lesson-learned to Canadians and behaviors and strategies for success in a rationed system, being pro-active, physically showing up to pressure gate keepers, thinking about what you are wearing, absolute politeness/friendliness with gatekeepers

from a community (communistic) point of view, any service you receive in a rationed system is taking away a service that someone else would receive, so there is indeed a moral issue. I waited four years while the neuropathy slowly moved from my chin up to my nose, accepting my GPs assurances that I should "just learn to live with it".

DW and I are however in a grey zone as far as taking early retirement, or not...one of the pieces of the puzzle was to become a sure as possible about the seriousness of this medical issue, rather than relying on my GPs best guess at the odds. I think he gets paid a bonus for keeping his herd of patients under an expenditure quota...so not exactly an unbiased stakeholder.

I had decided to go to the Mayo in Florida to resolve this, but thought I would see how far I could get with the "free" system first. My current plan is to pursue some natural therapies that I think I am making progress, with, and failing that, try some of the meds he prescribed (on my suggestion!), then step it up a notch and work with a US neurologist.

Of course, I can well imagine this would be of interest to our US friends considering changes to the US health care system.

 

[Kroeran]

And $4K would be your monthly private health insurance premium in the US now that you have a pre-existing condition.

DO I have a pre-existing condition? of what? given that I have been officially cleared, I would hope that this would at least qualify me as being non-pre-condition for insurance purposes

this is not an entirely theoretical point...I am continuing to consider making Florida my primary residence for tax and health care purposes post retirement

 

[Kroeran]

This must be very frustrating. $4k sounds like a bitter pill, but if you've done enough research to make you think this might be something serious, it might be a good investment. Especially if you'll be in FL anyway for something else.

So, what happens when a Canadian goes somewhere else for a diagnosis--how does one get actual treatment? Do you have to go back to your family doctor or care gatekeeper clutching your MRI results and the doctor's finding and try to get someone to then take the problem seriously?

Good luck, I hope things work out.

fortunately, $4k is trivial in the scheme of things, especially when it comes to health

...main thing is to go through the process, take prudent steps - now that I have the MRI, I am fairly confident it is not anything OBVIOUS, but everyone has an error rate.

It still could be something serious, but too unusual for Ikea-level healthcare to detect it, but doubtful...I am going to set that worry aside.

I am more interested in getting a confirmed answer as to what it actually is, so that I can try to figure out if there is a diet or lifestyle change that might mitigate it.

it could be a symptom of some more macro issue that should be dealth with

I looked at my blood scans, and noticed by uric a bit high-normal, my B12 and white and red bloods cells a bit low-normal, my specific gravity a bit high which can be dehydration...so I am eating a bit more meat, popping B12s, drinking black cherry juice to help reduce uric acid levels, and trying to drink more caffeine-free tea to raise hydration. I am hoping hydration and B12 might strengthen my blood cell readings and increase support to nerve sensation. We will see if I can push the levels closer to normal. Will do some testing for cash in Florida in January.

 

[Trek]

DO I have a pre-existing condition? of what? given that I have been officially cleared, I would hope that this would at least qualify me as being non-pre-condition for insurance purposes

this is not an entirely theoretical point...I am continuing to consider making Florida my primary residence for tax and health care purposes post retirement

Oh I don't now, you'd need to ask an impartial insurance rep (one that you're not going to buy from). I imagine since nothing was found you just wouldn't disclose anything about it and if you otherwise pass the insurance physical you'll probably be OK.

Worst case scenario would be the issue you suffer from turns into a real medical problem requiring expensive treatment after you've been insured in FL. Then if the insurance company was to find out you were seen in Canada about it, they would refuse your claim and not pay for treatment.

But that's just a guess and not meant to scare you. Just talk to a insurance broker before you move to be certain about the risks and your options, etc.

 

[samclem]

. . . Ikea-level healthcare . . .

 

[FUEGO]

I dont think your situation is related to your insurance. It would be the same if you were a cash customer. The problem is poorly run administration of the doc's office and your willingness to accept that.

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.

 

[Kroeran]

If I got a job with a large institution, would pre-conditions get grandfathered in, or are you in the same position as if buying private insurance?

 

[Tesaje]

The pre-condition clause depends on your insurance. My Fed govt contracts require no pre-condition clauses so they can't do that to us. But others have had all coverage denied when they got something serious because they failed to disclose previous treatment for acne. If they can, insurance companies can and will find an excuse to deny coverage.

What you describe is what happens in the US with insurance calling all the shots. It may be that the doc you saw simply doesn't know enough to diagnose your condition. It could be it isn't a serious condition. It could be the doc doesn't know what to do about it. With your low blood levels, I would correct that first but this is something that is poorly recognized or treated in the US too. Any sort of alternative treatment is not considered by most US doctors. If a prescription drug or surgery can't correct it, they have little interest in it.

In many cases, having the insurance call the shots on your treatment is worse - they have a strong incentive to deny coverage. Nobody will treat you without insurance unless you are a true emergency.

We have rationed care here too - rationed by insurance companies. Doctors are none to happy about that either. They would rather be the ones to deny coverage.

 

[samclem]

We have rationed care here too - rationed by insurance companies.

Food, houses, cars, swimming pools--everything is rationed I guess.

 

[Alan]

If I got a job with a large institution, would pre-conditions get grandfathered in, or are you in the same position as if buying private insurance?

In all 5 companies that I personally know about through my family there have been no pre-conditions thank goodness. When my son graduated from college I tried getting private insurance for several weeks but the insurance wouldn't touch him at all as he had been treated for clinical depression in his final year. I was shocked that they wouldn't insure him at all. Fortunately he got a job at a bank within a couple of months and there were no pre-conditions. As it happens he was already off his medication by the time he started and has been perfectly well since then (apart from taking a tumble from his bicycle breaking both wrists and requiring surgery with pins in one of them that would have bankrupted him if he was still uninsured).

 

[FUEGO]

If I got a job with a large institution, would pre-conditions get grandfathered in, or are you in the same position as if buying private insurance?

I think our policy through blue cross blue shield (from a small private employer) did not cover pre-existing conditions for the first 12 months IIRC if you did not previously have "creditable" insurance coverage. Whether Canadian public care would be considered creditable insurance, I dunno. Bigger companies may have better insurance since you probably have a lower risk of adverse selection vs very small company policies.

 

[Meadbh]

In my experience as a physician there isn't enough healthcare in the world, or healthcare providers, or physicians, or equipment, or time, to provide all the healthcare that everybody wants. There is, however, sufficient to provide all the healthcare that everybody needs. Ergo, healthcare is rationed everywhere in the world. Healthcare systems differ in the rationing methodology.

 

[Kroeran]

Food, houses, cars, swimming pools--everything is rationed I guess.

well, rationing by markets and price is different than rationing by government fiat

rationing of a publicly provided base service is one thing, forcing everyone into the one soviet system and making it illegal for me to pay a doctor to provide a service is something else

it only works because we can cross the border or go to the Mayo, which I may end up doing

 

[samclem]

well, rationing by markets and price is different than rationing by government fiat

rationing of a publicly provided base service is one thing, forcing everyone into the one soviet system and making it illegal for me to pay a doctor to provide a service is something else

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.