I think it's fair to say this is one of the biggest bones of contention in Canada when it comes to comparing my homeland's health system to that of the U.S. It certainly came up time and time again after the recent, tragic death of Natasha Richardson. You might recall the comments I posted from the Toronto Star website--all of them from Canadians (I assume), and many claiming that Ms. Richardson was moved to the U.S. because she was forced to wait too long in a Montreal emergency room. In actuality, Ms. Richardson was flown to New York because her family wanted her to be in her home state when she died. The Quebec hospital had nothing to do with that.
It's easy to see from that there is a Canadian myth that the biggest benefit of the U.S. private health insurance system is the ability of wealthy Americans to sail through waiting rooms on to their practitioners. The reality's a little bit different.
For us down here in a small city in the South, the time spent kicking around the waiting room for our general practitioner is exactly the same as it's ever been in the much larger cities of Montreal or Toronto. My wife says it's actually worse. The time between making an appointment and being seen by a GP is mainly governed but how busy the practice is, which can be anywhere between a few hours if it's urgent to a few weeks for non-critical things such as flu shots or vaccines.
Medical specialists, however, are another matter. In Quebec and Ontario, the wait times can be measured in months, depending on the specialist, with four to six months being usual. Here, the wait is usually measured in weeks, but I have a feeling that's dependent as much on where I live in the U.S., rather than the entire country in general. That said, there was even one occasion when I was able to see a specialist within one hour of making the appointment--during his lunch break to be exact, people in the South are just nice like that--but I'm sure that's pretty rare. Of course, just like visiting a general practitioner, I have to fork over a co-pay for each visit. For a specialist it's $45.00. It used to be $25.00 when we moved here, but the cost went up. Having to spend that kind of money when I'm already paying for insurance is extremely annoying, and it also serves to make me think twice before I see specialist (occasionally until my wife makes me go to one).
The question of course is, why do we have to wait so much longer in Canada? I can think of two possible reasons for this, though I'm certain others exist. First, in Quebec and Ontario the provincial government caps the salaries of medical doctors (see here). Makes sense, since the governments have to pay them. Because medical specialists make more money than GPs (this is true of the U.S. as well, which is why no one wants to be a GP anymore), these specialists can't (or won't) see as many patients per day or years as they can in the U.S. because they don't get paid for it.
Here's an example: one of my old girlfriend's dad back in Quebec was an ophthalmologist. He only worked four days a week in the winter and three days a week during the summer, plus he had several weeks vacation. Apparently this was because of the salary cap, which prevented him from seeing as many patients as he otherwise might.
The salary cap might reduce health care costs, but at the price of longer wait times to see a specialist. As discussed below, doctor shopping can also affect wait time and increase in overhead costs. This happens more frequently in Universal health care system, as seen in this publication.
The second reason is one of those things that make you go, 'hm.' Where I live now, in the sun-drenched land of capitalist hegemony, if I want to see a specialist I just call one and make an appointment. After, of course, I've made very sure they're in my insurance company's network. Wouldn't want to make a mistake about that.
Back in Canada, if I wanted to see a specialist, I'd need a referral from my GP. This isn't so bad if you're actually at your GP's office when you find out that you need one, but if you're not, it means you have to wait to see your GP for the referral, and then wait for the specialist. This is where the months start ticking by.
One line of thought about the 'two lines, all waiting' process Quebec and Ontario is that it prevents people from abusing the system. If you have to wait half a year to see a specialist, you might think twice about it before wasting everyone's time. The problem with this is that, as I was told by one of my former supervisors and a well-known medical doctor in Quebec, the referral system is really used to give the specialists more money. You see, without a referral, the provincial governments will only pay the equivalent of the fee for a general practitioner. And if the specialist insists on a referral from a GP, the GP also gets more money from seeing the patient. Win-win, as long as you're on the right end of the stethoscope.
Maybe other people in Ontario and Quebec will have different views on this subject I am sure.
As I mentioned above, a bit of a hot point is the wait times at hospitals. Based on my own experiences and the experiences from people I know, it is true that in Quebec and Ontario, the wait times in emergency rooms for non life-threatening conditions (such as tests, MRIs and CAT Scans and non-elective surgeries) are much longer. In light of what happened to Ms. Richardson, I can't state more unequivocally that if it is an actual emergency, the person will be helped immediately. My wife waited five hours as a teen to have her cracked wrist casted in the only hospital in her town, and my niece had to wait that long to have her broken arm casted in one of the many hospitals in Toronto, but I know from the day-to-day experiences of my brother in law who is an Emergency Medical Technician in Ontario (that is, an extremely highly-skilled paramedic), that patients in dire need are rushed off the ambulance and into care as fast as they can park.
But if your bronchitis is acting up again and it's midnight on a Wednesday, bring a book. Maybe some DVDs.
Here's why: In Quebec and Ontario, because there isn't a co-pay, if it's midnight on Wednesday and you've got the flu, you might just haul your butt to the hospital. In America, where an emergency room visit costs $500, you're going to swig NyQuill and tough it out until you can see your much, much cheaper GP in the morning.
Recognizing this problem, the Quebec Government briefly considered instigating a $5.00 co-pay (called ticket modà ©rateur or "moderation ticket") for everyone showing up at the emergency room, in the hope that even such a modest fee would get some people to cool their jets before hopping on the Metro. They didn't do that, but they did create a series of public medical clinics (known as CLSC) for minor illnesses or non-serious injuries. (Ontario has many 'walk-in clinics' as well). As far as I know, however, these CLSCs haven't put a damper on the number of people showing up at hospital emergency rooms for things that aren't emergencies.
You might be thinking that the $500 for going to the emergency room, or even $25.00 to go to the clinic leads to rough-tough Americans, as opposed to whiny Canucks who run to the hospital every time junior has a runny nose. The drawback, however, is obvious. Where people will hesitate to go to the doctor, you get sicker people, something we've witnessed firsthand. One of our good friends who consistently avoids seeing a GP because of the co-pay has ended up in a local emergency room twice, transported there by ambulance, which adds another $500; if you do not have medical insurance, add another $300 or $400 for the ambulance ride. A trip to emergency, even with insurance, can be extremely expensive. As a friend told me before I moved to the U.S., regardless of your medical insurance, you don't want to go to the hospital very often.
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