Health Care System in Canada – At a Glance
The health care system in Canada runs on the principle of universality: every person has free access to basic health care, with a few exceptions.
Compared with many industrialized nations, Canada's health care system is excellent in its standards of care and accessibility.
Some of the problems being faced are: long waiting lists for some surgeries, delays in some kinds of cancer treatments, a shortage of family doctors and overcrowded emergency rooms. Health care falls under provincial jurisdiction but a federal ministry of health ensures that the provinces adhere to the Canada Health Act. Otherwise, provincial and territorial ministries oversee the administration of what is unofficially called Medicare.
Public VS Private
Debate rages concerning Canada's health care system and, as some people claim, it's increasing Americanization. Private clinics do exist in Canada and there is the fear that with long waiting lists in the public system, people with money will want to pay for procedures rather than wait, the result being a two-tiered system: one for the rich and one for the poor. With a limited number of specialists in the country, there is also a fear that they'll move to the private clinics and the waiting lists in the public health system will grow longer. But for now, those clinics are funded with public funds and there is officially no queue jumping. User fees and extra billing by doctors who also bill the province are not allowed under the Canada Health Act. When a person covered by the provincial health plan goes to the doctor, that person does not pay a fee for the visit. The doctor will bill the provincial plan. This pertains to medical doctors only. Psychologists and naturopath doctors, for example, are not covered under provincial plans, chiropractic doctors are only partially covered in some provinces, not at all in others. Some services from medical doctors, such as medical examinations for summer camp forms or visits to get a medical note for work or school absences, are also not covered and a small fee will be levied. Things not covered under Canada's Health Act, therefore, have to be provided for with private funds. Prescription and non-prescription drugs, dental services, certain tests, nursing homes and vision care are examples of expenditures people must cover out of their own pockets via direct fees or private insurance. Some provinces partially cover prescription drugs and, for the most part, the government pays for prescriptions for the elderly and people on social assistance.
Going for additional cover
Private insurance plans for individuals and families can be purchased that include a variety of the above, uncovered services. Some of those benefits include: private or semi-private hospital rooms, chiropractic and massage therapy, travel insurance, speech pathology, naturopaths, psychologists, prosthetic appliances etc. Plans vary, but the amount of benefits included is directly related to the cost of the plan. For an individual person, a very basic medical and dental plan can start at around $70 per month. Family plans work out less per person and start at around $140 per month, but for that price very few benefits are included. It is possible that you would be covered by your employer as many companies offer employee benefit packages that include cover for all those things for you, your spouse and your dependent children. A portion of the cost of insurance is often deducted from your pay cheque and the company chips in the rest. If you work for yourself, however, or if you are a contract worker, you will probably have to purchase your own plan. The cost of the plan can be deducted as a medical expense on your income tax return.
Knowing Where to Go
Hospitals, doctors, walk-in clinics, community health centre's and other health care providers are all available. In some provinces, groups of hospitals have merged in attempts to keep costs down. Every major city has several hospitals, smaller cities will have at least one and rural areas usually have a hospital nearby or a clinic within the community. However, rural areas continue to be underserviced despite government incentives to get doctors to set up practices there.
Doctors
Most Canadians choose one family physician to take care of their basic needs. This ensures that the doctor who treats them is someone who knows their medical history. If their medical problem requires a specialist, their doctor will refer them to one. To find a doctor you can ask friends, co-workers and family for advice or you can look in the business section of the telephone book. You can also try using the provincial College of Physicians and Surgeons as a resource. The colleges are the regulatory body for doctors in each province and many have a ‘find a doctor' service you can access over the phone or even online. Some of the colleges just have a list of doctors whom you can call and see if they are taking new patients. Others actually have a list of doctors in your area who are taking new patients. Doctors limit the number of patients they accept, so you may have to look around a bit to find one who is available. No one is obliged to remain with a doctor if they are dissatisfied. If you find another doctor whom you prefer, you can have your records transferred. You are also entitled to a second opinion from another doctor without changing doctors. This can be done if surgery has been recommended or if a serious condition has been diagnosed. Patients must make an appointment to visit a doctor. A well-organized doctor's office should be able to fit you in on the day you call if it is a serious problem. It is recommended that everyone in the family gets a yearly check-up.
Hospitals
There are more than 1,000 hospitals in Canada. Most are general hospitals, but small percentages are convalescent or chronic care hospitals. Ninety-five per cent of hospitals are private, not-for-profit corporations. The administrators who manage them report to hospital boards made up of public trustees. Clinical staff makes the medical decisions, however. Hospital emergency rooms have been strained under cuts to funding. Some emergency doctors complain that the emergency rooms are overcrowded because people come in with trivial problems, especially as many people are without a family doctor. Both rural and urban areas are experiencing a shortage of family physicians (and specialists) so it's likely both a shortage in funding and non-emergencies have led to the problem of long emergency room waits. In the case of an emergency, an ambulance would take you to the nearest and least busy hospital emergency room. If you are scheduled to go to the hospital for any reason, you may be slated to go to a hospital at which your family doctor has hospital privileges unless you are going in for a service available at only certain hospitals or for surgery. Where you go for surgery depends on the surgeon involved. If a life is in danger, there is an emergency telephone number to call; in most cities that number is 911. This will get you ambulance, fire or police services immediately. In other communities you can call the operator by dialing 0. If the doctor determines you did not need the ambulance, you will be required to pay for it. In some provinces, part of the ambulance fee must be paid even if the ambulance was required, although some private insurance plans cover this fee.
Clinics
For visitors, people without a family doctor or for after-hours care, an alternative to hospital emergency rooms is a walk-in clinic. Some are small, staffed by one or two doctors, while others are comprehensive clinics with their own specialists. They are not 24-hour care facilities but the hours are longer than those of a regular doctor's office. If you need more serious care or X-rays, the clinic may send you to a nearby diagnostic centre where they specialize in X-rays, ultrasound and lab work. These are privately run, but if you're covered by provincial health care the tests will be covered. The clinic may also send you to a hospital emergency room.
Controlling Disease
Canada's public health laws protect its people in various ways. One of those measures is compulsory vaccination to inoculate against certain diseases. Polio, diphtheria, mumps, measles and chicken pox have been eliminated or reduced because of high public health standards. It is the law that children must be immunized against serious infectious diseases such as diphtheria, polio and tetanus. Children are not allowed to go to school without an immunization card to prove their vaccinations are up to date. Most provinces have developed publicly-funded programmes to inoculate girls in school. Some programmes start as early as grade 5, others are in grade 8.
Eligibility and the health card
Provincial health insurance plans cover essential medical services for all Canadian citizens and permanent residents. Visitors must have travel health insurance. Visitors in Canada on a working permit may be covered by a provincial plan, but this depends on the province, the job and the length of contract. In Quebec, for example, workers from France with contracts for more than three months are eligible for coverage for the time of their contracts. Quebec also has agreements with citizens of Sweden, Finland, Norway, Denmark, and Portugal and does not have an agreement with the United Kingdom. It is important, as a worker that you check with the province you will be working in as to what their rules are. Moreover, even if you are covered, there may be a waiting period before you are entitled to the coverage.
Obtaining a health card
If you are eligible, you must obtain a health card. Each province has its own particular requirements. When you arrive you must apply right away for a health card at the province's ministry of health in your city. When you apply you must bring with you your birth certificate, your immigration visa and passport. Some provinces also require documentation showing your name and address and your signature. Every member of your family must get a health card. In most provinces you will be eligible right away, but in British Columbia, Ontario and New Brunswick there is a three-month waiting period. Temporary workers may face different waiting periods in those and the other provinces. For the time that you as a worker are not covered, you should buy cover through a private insurance plan, such as travel insurance from your home country. If you move to another province, you may face a waiting period before being eligible for the health plan in that new province, so you should apply right away. In the meantime you will be covered by the plan of the province you just left. If you are simply visiting another province, your card can be used in an emergency.
Medicines
Prescription drugs are strictly controlled in Canada. There are many examples of drugs that are available over the counter in Europe and America that are available only by prescription in Canada. Most drugs for minor maladies such as headaches, colds and sore throats are available in the aisles of the pharmacies. When you need something more serious, your doctor will write a prescription for you which you take to the pharmacist to get filled. Prescription drugs can be quite costly, which is why most people get private insurance, which covers all or part of the drug costs (employer plans do this too). Herbal medicines are available over the counter in both mainstream drug stores and natural/health food stores. Health Canada monitors such products, which are regulated under the Natural Health Products Regulations.
Dental services
Unfortunately, dental services are not covered under provincial health plans. You can get cover through your company's benefit package (if available) or through a private insurance plan that also covers prescription drugs. If not, you can pay as you go. It is recommended that people, including children, get a check-up and cleaning twice a year and X-rays every few years (to identify cavities and structural problems). A cleaning and check-up can cost from $60 to $95. Filling cavities can cost hundreds of dollars, which is why it is cheaper to have regular check-ups and catch problems before they become serious. Teeth, their health and their appearance, are a high priority for Canadians. It is very common for teenagers to undergo orthodontic work to straighten teeth and bites. Orthodontic work is very expensive, however.
Pregnancy
Most women choose to have their babies in a hospital, but home births with a midwife are gaining popularity. Pregnancy is taken seriously in Canada and the standard of care is excellent. In addition to a family doctor monitoring a pregnant patient, the prospective mother will likely solicit the services of an obstetrician/ gynecologist, even if the pregnancy appears to be normal. Hospitals and clinics offer childbirth and child care courses. Abortion is a very controversial subject in Canada, as it is elsewhere in the world. Demonstrations and serious violence have shown that. Regardless, you should know that abortion is not illegal in Canada, although it is not available at all health care facilities.
Accountability
Provincial colleges of physicians and surgeons regulate doctors and handle complaints about doctors. But, there are also complaints about the colleges for being inefficient and protective of doctors. Despite this, the colleges remain the only real mechanism for accountability, although a new and controversial website www.ratemds.com has sprung up allowing patients to write online about their experiences with a doctor. Otherwise the only other option is through legal means, in terms of malpractice lawsuits, which are also cumbersome and fairly expensive.
Regards,
SReja
Sources: Books, Magazines, Articles
