Even after you've gotten that elusive appointment with a specialist, getting access to medical equipment like MRI machines for non-emergencies can also be very difficult in Quebec and Ontario. My same Ontario Paramedica brother-in-law had to wait two months for an appointment with a specialist and have an injury scanned by an MRI machine. He needed the scan to see if he needed surgery. In the meantime, he wasn't able to work and in pain.
I'm certain that long wait times to use this kind of equipment are also related to the salary cap I discussed above. I'm sure that there aren't as many MRI machines either, since the provincial governments are the ones paying for them. Here where I live in the States, I know I could get an MRI scan within a few days if I wanted it. Of course I'd have to pay the deductible costs my insurance company didn't cover (about $500, of course).
Again, the small city where I live probably doesn't represent the entirety of the U.S.
Cost Issues and Management
As far as I've been able to tell, three major and different issues affect health care costs in the U.S. and in Canada.
The first is the subtle but very real difference in the philosophical approach to health care between the two countries. Simply put, Canadian doctors aren't generally as proactive as American ones. In Canada, the philosophy is, 'if it ain't broke, don't fix it', which--and this is a guess--probably comes either from the fact that they won't necessarily be paid for that extra series of tests, or from the fact that they know the patient will have to wait several more weeks or months before the tests can even be done.
In the U.S., however, the thought is generally, 'it ain't broke yet, but it might break later, so let's look at it right this second.' This can be equally annoying. In Canada, you have to specifically ask for a doctor to do more than the obvious, most likely to minimize wasteful spending if the test is not warranted. In the U.S., you have to ask them not to freak you out over nothing. I've even seen this medical hyper-vigilance at our vet's office: whenever we take one of our moggies for a checkup, it seems our cats are always about to drop dead if we don't do any given procedure immediately. My wife's dentist seems to be in a constant state of near-panic over a dental procedure he insists has to be done now, which is the same procedure that that her dentist back in Toronto never worried about. I've personally been asked by a particular specialist to have some (expensive) tests done just to be on the safe side.
This particularly American penchant for nipping things before the bud has formed certainly has benefits--nothing like being able to cure the disease before you have symptoms--but on the other hand, medical procedures you don't strictly need are also costly and time-consuming. I've also read comments elsewhere saying that medical doctors sometimes order medical tests to lower the risk of lawsuits over missing anything.
(Granted, nothing's universal. My wife was speaking with a neighbor last week, who said that it took her over two years to convince her GP to do a particular test that it turned out she desperately needed. Apparently the GP just thought it wasn't necessary, and that was that.)
The second issue is the administrative costs for the different health care systems. In the U.S., almost every hospital has at least an entire building that is entirely devoted to administer insurance claims from various different private companies (and the government, in the case of Medicare for seniors), and things like billing patients for insurance deductibles, co-pays, etc. If the patient doesn't pay quickly enough the hospital needs to give the file to a collection agency, which also adds to the overall administrative costs. And there are a lot of people here who don't pay their medical bills, whether they have collection agencies after them or not. Every time an American goes to a hospital, a clinic or a private medical practice, they always get a statement sent by regular mail detailing all the medical costs associated with your visit. And yes, the first question the receptionist asks really is, 'Which insurance company are you using?'
In Canada, the costs are dealt with directly between the hospital and the government, which I am certain significantly reduces overhead and administrative costs. I wouldn't be surprised to learn that the department managing medical claims in a typical Canadian hospital only has a few employees.
In the same way that Canadians have no financial constraints against going to hospital emergency rooms, when I lived in Quebec I had family and friends who would go to different specialists to get a second or third opinion on the same problem. Why not? It was free as long as they were willing to wait for an appointment. In the medical profession, this is known as doctor shopping.
The hidden problem with this is that medical professionals in Quebec and Ontario are paid by the number of patients seen and by what has to be done for the patient (surgery earns more than a checkup). What this means is that the government could be paying several times over for the same service for the same patient. I couldn't find what the costs might be for these doubled specialist appointments, because of the lack of co-pays. There is some literature on and the reader is referred here as an example.
Obviously it would be possible to do this doctor-shopping around here, but when you have to pay $45.00 out of pocket each time it's probably less tempting. We certainly don't know anyone who's done it.
This is interesting: According to my neighbor who comes from France, under the French health care system, the patient pays up front for the medical visit, and then gets reimbursed later by submitting the receipt to the government. I am certain that this approach puts a damper on the over use of medical services, and probably their accessibility as well. According to other French folks I know (this includes my neighbor), they still believe their system is much better than the ones from Canada (discussed further below).
Where I live, I often read in the media about how terrified some people are about having their health care managed by the government (I assume each state would manage their own health care system, the way each province does in Canada). They don't want a faceless bureaucrat telling them what they can or cannot do. What they don't seem to realize is that with private health care, their choices are being dictated by a faceless corporate peon. Ultimately, it will always come down to a human being who doesn't know you personally making the decision about what will and won't be covered.
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