I have a guest post running over on Raising My Boychick today! It’s part of the Womanist/Feminist Parenting Primer, conceived by the fabulous Arwyn. After you read my completely non-authoritative primer on Canadian health care, hop on over and read my post, called Talking to Strangers.
I’m not a doctor or a nurse or a phrenologist and I don’t even play one on TV. I’ve never worked in health care other than a brief stint as a candy striper in the early 90s. But I have lived in Canada my whole and entire life, and I drew my first breaths in a Canadian hospital. So I decided to share my own perspective on our health care system, which we call ‘Medicare’. I am at least as qualified as any other random Canadian, after all.
This is not comprehensive, because I am not well versed in the complicated and bureaucratic intricacies. I’m limiting my discussion to what I would call the majority of cases and my personal experience. If you have anything to add based on your own experience please do share it in the comments. 
I was prompted to write about Canadian health care when I saw this ad on a website:
As a Canadian this ad sort of shocks me. You see, we speak about the evils of ‘American-style health care’ all the time. During election campaigns politicians accuse each other of wanting to introduce a two-tier medical system that will kill us all. It doesn’t surprise me that they found a Canadian who’s unhappy, we are a country of 30 million people after all. But I think that most of us find this ad surprising given our general assumption that Canadian health care is better than American health care in the vast majority of cases.
So how does Medicare work? The health care system is regulated by the Canada Health Act and administered through the federal and provincial governments. There are slight variations from province to province, but the system remains largely the same across the country because it is required to. Here are the key components:
1. It’s universal – Everyone is required to participate in, and be covered by, Medicare. There is no such thing as being denied coverage because you’re out of network or have a pre-existing condition. There are no private insurers. There is a 3 month waiting period before Medicare coverage starts when you move from province to province, but you’re covered by your previous province during that time. Being uninsured is not something we understand, and it’s not even possible for most Canadians.
2. Publicly administered – Medicare is administered by a public authority in each province and territory. The plans are operated on a not-for-profit basis and the health authorities are accountable to the government.
3. Covers all medically necessary services – In Canada it is illegal to bill directly for a ‘medically necessary’ procedure, anything deemed necessary must be covered under Medicare. Pretty much any services offered by a doctor or hospital are considered medically necessary, such as regular office visits, emergency services, surgery and diagnostic tests. There are no co-pays, user fees, or deductibles. When I visit the doctor or hospital I present my health card and they bill the plan directly, I am completely uninvolved in the process.
4. Low or no premiums – In some provinces individuals do not pay any premiums for health insurance. Here in BC we do pay set medical premiums. The rates are $54 / month for singles, $96 / month for couples and $108 / month for families of 3 or more. If your family income is low you are subsidized in whole or part. If you are employed, your employer generally pays half your premium, so my family of 4 currently pays $54 / month.
Some services are deemed ‘uninsured’ and aren’t covered by Medicare, such as dental care, optometry, prescription medications, cosmetic surgery and naturopathy. Most employers offer an extended health plan to their employees, which covers some portion of selected services. For example, I am reimbursed for a portion of my dental and prescription costs, and I am covered for emergency care if I travel outside of Canada. The premiums for these plans are very low, or may be completely covered by your employer.
Most Canadians are generally satisfied with our system. According to our government in 2005 85% of Canadians were satisfied with the health care they received. And we’re getting good value for our money. In 2005 per capita medical costs in Canada were $3003 USD compared to $5635 USD in the United States. The per capita costs in the US from public sources were $2570 USD, compared to $2108 USD in Canada. Americans are already spending more for public health care without universal coverage.
There are downsides to Medicare. Some patients are dissatisfied with the care they receive, although I would venture to guess that’s true in every other country in the world as well. No matter how you fund medical care there will be doctors who make mistakes or nurses who are having a bad day. Because there is no option to go outside the system it leaves people who want to pay a premium for ‘better service’ without recourse. And it doesn’t allow doctors to set their own rates, since their rates are set by the public health authority.
But the truth is that we are not dying in droves. Our life expectancy is higher and our infant mortality rates are lower than in the US. We generally trust the system to care for our urgent needs. And we are thankful to know that in any circumstances we can count on our health care needs being met. We won’t become uninsured if we lose our jobs. A serious illness or injury won’t bankrupt us. Any of us. I think that’s a good thing.
Well, I don’t know what to think about it. As a Canadian that has had 2 pre-term pregnancies and those babies have grown to be as accident-prone as boys are expected to be, I think it is well worth the $108 per month. The urgent care clinic visits alone have earned my money!
HOWEVER, I don’t think it’s easy or particularly good service that we get here.
I have been turned away with a screaming baby because it was 1/2 hour until the clinic was closing and they had 4 patients waiting (and that was with a poked eye!)… they directed me to drive another 2o minutes to go to the hospital emergency room instead.
BUT our hospital is DIRTY, it is paint-chipped, grungy and germ-infested on every level. They are constantly fighting super-bugs and infections that are transmitted from room to room. The wait in the Emergency is usually 3 hours or more (even if you have a severed finger as one friend found out– and yes they took so long to see him that he lost it forever). Basically if you don’t come in an ambulance you take a number and sit in those nasty dirty plastic chairs with all the other sufferers until; they call your number. In my own experience, the shower in the post-natal wing was a terrifying, rusty closet of blood and filth for the ward patients! (I understand they have renovated that area since — thank heavens!)
When my youngest broke his right femur, we had a stay of 19 days in the children’s ward. We had the one surgeon that came and checked on him every 2nd day. No other doctors looked, no second opinions, and the nurses were so busy that they were very thankful that I “moved in” to the cot next to him and did 98% of the care and maintenance for him…. he was completely prone in traction so he needed hand-feeding and help with the other bodily functions. I felt for those nurses, they work HARD for their money!
Withing for tests and waiting for treatment I think have to be our system’s biggest downfalls.
My MIL with MS experiences a terrible callousness sometimes. And my little neice cannot get a vital surgery in BC that she needs if she ever wants to overcome a birth defect to live without a “bag”. (But they can offer a lesser surgery to make the bag come from her belly button — go figure).
The resources are not there for the people on the front lines (maintenance, cleaning, nurses, equipment) maybe it needs a good top-down audit to clean it out and manage the money?! I don’t know, like you I am just and average user.
The thing with a national health care service – and Canada’s is the fourth I’ve experienced – is it can’t be all things to all people, because we’re sharing resources. It is not fancy, there are no bells & whistles, it is not perfect. It bothers me when people compare their national health service which covers EVERYONE to the fancy-pants private health service you can get in the US that covers the few.
What it is, though, is fairer and more flexible. Your health care is not tied to your job, your income, your wealth. You won’t be bankrupted by medical debt. You won’t be refused coverage, and forced to pay 100% of expenses out of your own pocket. You don’t have to check with your insurer to make sure your fitting child is going to the right hospital – you know you can go to any hospital. You’re not drowning in paperwork. Etc. Etc.
Private health insurance can be amazing, but it means a LOT of people, including some of my friends, do without any insurance or have massive copays or worry constantly that they will lose their insurance or fill out pages of paperwork or find out they’re not coverd for something or have to jump through five million bureaucratic hoops to get care. I sometimes wish more Canadians would visit other countries with national health services, they’d see that by and large, theirs is not bad. I haven’t watched the ad – sick of the whole thing, tbh – but I wonder if it ever occurs to this woman what would have happened if she’d been a US citizen with no health insurance?
A few years ago I watched a show about how women give birth from several different countries all around the world. After watching that program I decided I would never ever complain about our health care system again.
The system always meets my expectation of standard care. I also think that facilities will reflect the area you are living in. All our facilities are up to date, clean and generally have the latest technology because we live in a growing, large city in the Greater Toronto Area. If I chose to live in the north, then I would expect older buildings, equipment and longer waits for tests and procedures.
We didn’t have a family doctor for 7 years and used walk in clinics or the emergency room and generally don’t have to wait very long in the emerg. because we are there for a real concern, very high fever, a cut needing stitches…and again I would never complain because I am thankful I don’t have to worry about the cost or that I can access care.
We actually went to our family doctor today for a bug bite that has apparently gotten infected on my husbands arm. We walked in, showed our card and was immediately led into the doctors office – no waiting, no cost and comprehensive care.
If we grew up making our health our personal responsibility then the system would not be clogged with doctors diagnosing common colds.
I’m grateful to have grown up in Canada and can’t even imagine living anywhere that didn’t offer me the assurance of universal health care.
I’m in Whitehorse, Yukon Territory right now and the hospital is pretty swish. The mums I’ve met have had great experiences giving birth here. I know some areas have notsogreat facilities though.
Thank you for this piece Amber. Hand it to you to do a “review” of Canadian Health Care. Good on you!
My experiences withour health system have been very good. Maybe it’s because the hospitals I’ve used have been in larger and mid-sized cities like Victoria, Duncan and Courtenay, but I have never felt that our hospitals were grungy. Well used perhaps, but always clean. I have had to wait in emerg for up to 2 hours before (who hasn’t?) but they triage patients so I know the ones getting in before me had bigger fish to fry. I prefer walk-in clinics when they are open.
I’m remembering that I have heard not-so-good things about Vancouver Women’s Hospital and Victoria General’s matrenity ward. I think because these two places are over=run with women giving birth. Nurses just don’t have the time to properly care for pts, teach breastfeeding initiation, etc. They all can only do the bare minimum. Sad. Interesting that it’s in the big cities that it seems the worst. My small hospital gave me fantastic care when I had my first daughter. Nurses had too much time on their hands!
Anyway, there is so much to say on this issue but all-in-all I’m in favour for our neighbours to adopt our system. My girlfriend in Chicago is constantly worried about health care because she is only covered when she has a job, and as a non-tenure university prof, that is only now and again. I have heard more horror stories about health care the way it is now in the States than horror stories from fellow Canadians.
>>Our life expectancy and infant mortality rates are lower than in the US.
Life expectancy is lower or higher than the US? Just checking whether I’m understanding correctly or there’s a typo.
I would love to have health care not tied to jobs. We’re fortunate that both my husband and I have stable (we think) jobs with health insurance, it just doesn’t make sense to switch doctors and plans because of work.
Lady M…we have a higher life expectancy and a lower infant mort rates than the us.
our hospt are a bit grungy..even based on the opinions of the people working there…but again..crummy contracts for over worked cleaning staff and nurses..the hospt have my sympathy.
preventative care would help issues like ER waits. I am sick of seeing people in ER with ailments that would wait till the next day and a trip to the doc or walk in clinic.
Better Senior Care would help too. We were told that that is what the care homes are TOLD to do- send their unwell seniors to ER instead of having the staff or on call docs to deal.
I also think it depends on where you live. I have used the care in the Fraser Authority and the Vancouver Coastal authority and have never had to wait or be turned down for tests, care etc.
To have home visiting midwives covered by my care is to me amazing.