In Canada, residents and citizens are recipients of a socialized provincial insurance plan. Although the specific terms of what is covered might differ slightly by province, most of the major aspects remain the same. Trips to the doctor are free and do not include any type of co-pay. The cost for the healthcare is covered through our taxes.
In Ontario, the Ontario Health Insurance Plan or OHIP, covers the cost of every doctor visit, visits with specialists, admissions to the hospital, any necessary surgeries, and so on. Certain treatments are limited by their needed frequency. For example, OHIP will cover the cost of a Pap smear once every three years as that is the standard frequency recommended by Health Canada. In the event however that you test positive for HPV or have an abnormal reading, or have a family history that requires more frequent screenings, OHIP will cover the cost of those as well as they are deemed medically necessary to occur more frequently.
Similarly as someone with Crohn’s, I require frequent colonoscopies, more than might be otherwise covered, but don’t ever have to worry about paying for the procedure.
All of my surgeries and hospital admissions have been fully covered. What isn’t covered is if I decide I want a private room. Interestingly, because I’m immunosuppressed and because my symptoms are similar enough to C. Dif for offer a concern, I often get a free semi-private or private room as it is deemed necessary. This is especially convenient for me since that usually means I get my own bathroom. Again, what is covered is deemed by what is considered medically necessary.
There are major gaps in coverage however, here in Ontario in particular. Prescriptions for example, are not covered by provincial health insurance. In some provinces they are. Although it isn’t covered under OHIP, low income individuals in Ontario are eligible for provincial prescription insurance under a plan called Trillium. The coverage is determined by your total earnings, and issue you a related deductible. For example before I was on disability, I had a total of $400 deductible which was spread out across 4 quarters of the year ($100 for the first 3 months, etc. etc.). Since my Remicade costs $10000 every six weeks, I met the deductible pretty quickly. Now that I’m on disability, I have prescription insurance provided through that program, with no deductible.
Some medications, like my medical marijuana which is my only at home treatment for the chronic pain and nausea I experience, are not covered.
Another major gap is that eye care is not covered. Trips to the optometrist are out of pocket, except for one a year for children under 18, and for people who suffer from conditions that can affect their eyes such as diabetes. Dental Care is also not covered.
One of the most popular arguments against socialized medicine is to point to the increased wait times that can occur as a result. Many believe that that is the result of more frivolous cases coming to waste doctor’s time. While a very small percentage of cases might have that as a problem, my experience is that a bigger issue is the lack of sufficient doctors and hospitals.
Canada has been experiencing a brain drain of talented doctors going over to the US because they can make more money there. Interestingly, many doctors who have worked the two systems have said that they prefer the Canadian one. Some actually come back here to practice, unable to handle the devastation of treating patients too late because they couldn’t afford to come in sooner.
Insufficient family doctors and not enough nurses is not a cause of the socialized system but rather a lack of a socialized medical school can be said to be blamed. While a cap on earnings might discourage some, many devoted individuals cannot afford the cost of the schooling necessary. It is also caused by an aging population with not enough doctors in the area of specialty most needed by them.
Because there are not enough Family doctors, and because some people don’t know how to find one, there are cases where people are forced to turn to the ER for conditions they might otherwise have been able to treat with their own doctor.
While the wait times at hospitals can be difficult, they are in fact managed based on severity. During my own admissions and visits to the ER for example, I have averaged anywhere from a 20 minute wait to something like 8 hours before seeing the doctor. The average lately can be between 1 hour and 3 hours to see a doctor. I have, however, also received medication and xrays before seeing the doctor. It often depends on whether you have a nurse willing to bug a doctor, or enough of a report from triage to be able to speed up the process.
My total wait in the hospital might be longer, but that is usually because I am waiting on lab results, and to see if I’ve gotten better in any way in that time.
When it comes to tests like MRI’s and CT Scans, the wait times have also been listed as a concern. What a lot of people don’t realize is that the longer wait times don’t refer to emergency scenarios but rather to regular screening. Each case is designated as Life Threatening, Emergent, Urgent, or Regular. Life threatening cases get priority, and Emergent cases are immediately after that. Urgent are given higher billing over Regular screening. That doesn’t mean that regular screening always gets pushed off. The hospital sets aside a block a day each day for those cases, it just means that the actual appointment might be scheduled months in advance.
I’ve had MRI’s, Cat Scans, and other imaging tests done the same day I arrive in hospital. When it is necessary that the scans be immediate, it can happen. If a patient is scheduled for a regular or urgent screening but finds their symptoms worsening, they do have the potential to tell their doctor, who can then reclassify their case if they believe necessary.
No matter what right wing demagogues in the US might have you believe, a person in a car accident who needs an immediate CT Scan to find out where in relation to their spine a piece of debris is won’t be left waiting for days or weeks to get the scan.
Would Adding a Two-Tier system including privatising solve wait times?
No. Emphatically no. Not unless privatisation also included the building of privately funded hospitals, which is unlikely. In the case of privatisation the same resources would be shared not according to need but according to who could afford to cut the line. Essentially people with money would be given access to faster treatment regardless of whether it was necessary or not. Now in addition to dealing with the time restricted by emergent, urgent, and life threatening cases, regular cases would also have to schedule around paid for spaces. The waiting time for people who couldn’t afford it would increase. Only a small population would find their wait times reduced. We would essentially have a medical system in which people with money are given care preferentially over people without money.
Moreover, unless Canada also creates a system where more people have the option of going to medical school – by increasing class sizes so more people get accepted, and providing the cost of school so that low income individuals can also afford to become doctors – the number of doctors and time available for public patients would decrease thus increasing wait times and reducing access to necessary medical care.
What Would Solve Wait Times?
- Building more hospitals and clinics so that there are more spaces available for doctors.
- Socializing post-secondary education and increasing the number of medical schools so that more people can become doctors.
- Hire nurse practitioners as triage nurses so that when they see people come in for colds, flu, and other ailments that could be handled by a nurse practitioner, they can give them a prescription and send them home right away. Note that intake nurses already perform quick exams including checking blood pressure and temperature.
- Pay nurses better and hire more of them. Many Nurses work 12 hour days, sometimes as long as 16 hour days. They should be able to afford not to work that many hours and there should be enough nurses that they don’t have to work such long hours.