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THE ERISA COMMITTEE

<nobr>Jan 22, 2008</nobr>

"Letter from Canada" -- Impressions on the Canadian Health Care System

Paul Jemison of HP and a former ERIC Board member moved back to his native Canada. Still with HP, he agreed to occasionally contribute his personal impressions and experiences with the Canadian benefits system, particularly health care coverage.

September 2007

Access and wait times are the major issues here. Established doctors are very reluctant to take on new patients and even those just setting up practices are being very selective about the number and types of patients they will take on.

The doctor we used before we moved 15 years ago did take us back, but only after some in-depth conversations that my wife had with his office manager. I have already availed myself of his services, and since we do not yet qualify for the government program (three-month waiting period, so people do not try to game the system), I had to pay the full cost on my own and will get reimbursed via a Blue Cross "gap" program we signed up for (which HP paid). His charge for an examination of a nasty bug bite infection, a quick overview of my recent medical history, and prescribing some drugs for the infection cost me $57 (Canadian). I visited a walk-in clinic the weekend before I saw him and that examination cost me $40. Drug prices, at least the ones I used, seem much lower here -- the first set of antibiotics cost me $14, including a $9 dispensing fee. I later had a very major antibiotic that was required to clear up the infection -- high potency, multiple times a day for over two weeks cost me $58.

The wait time at the clinic was about 10 minutes on a Saturday morning and I had to wait about 1 1/2 days to get in to see our doctor.

There are some stories in the media of people with life-threatening situations having to run to the U.S. on their own dime to get treatment because the wait times here were such that they would die/go blind/etc before they could get the necessary treatment. There are a couple of court cases working through the system right now for cases such as these where the people have applied for reimbursement from the government scheme and were denied. Given a precedent in Quebec, it would not be a surprise if the courts rule that the people are entitled to the reimbursement on the basis that the extended wait times violates a provision of the Canadian constitution. Things could get really interesting if that happens.

There is some extra frenzy around these situations right now as there is a provincial election in Ontario set for October 10, so the politicians and the media are pumping things up a bit.

The newly elected head of the Canadian Medical Association is a strong proponent of having parallel systems, one public and one private for those who are willing/able to pay extra. That idea has strong proponents on both sides of the argument, but going that way would require a change in federal law to ever happen. With the current federal ruling party being in a minority government situation, I do not see anything happening there as tampering with universal access, which is usually referred to as the stepping on the third rail for Canadian politicians.

(Healthcare is a provincial responsibility, but a good chunk of the funding comes from the feds and the regulations state that if a province allows "extra-billing," which is how the private system gets characterized, it does not qualify for any federal funds.)

Several doctors have figured out how to work around the system for some services (e.g., physical exams and some diagnostic services), but there is no alternative for more specialized services or hospital access. I still need to learn how they do so. Interesting that the prior prime minister availed himself of one of these services, but he has the kind of serious money such that cost was not an issue for him.

November 2007

A short update of the healthcare situation from Canada:

Ontario, (largest population province in Canada), had an election in October. Healthcare was an election issue, but was overshadowed to a large extent by a misguided campaign initiative from the main opposition party to fund private schools. The ruling party increased their majority in the election, despite having upset many people with the imposition of a special healthcare surtax in their first term and declaring that they would not drop the surtax in their next term even though there was a current surplus in the provincial budget. Their argument against dropping the surtax is that the funds are required to help meet future requirements due to the aging of the population.

Wait times continue to be an emotional topic -- the incumbent party noted during their campaign that overall wait times have dropped during their tenure but they were fairly quiet about what the actual results were. As usual, looking into the details can present a somewhat different picture, such as:


  • wait times for cancer-related surgeries have dropped from three months to two months since 2005

  • cataract surgeries now are at 153 days, down from 311

  • knee and hip surgeries are still above target at 182 days

  • MRIs -- no real change at 110 days

The still too-long wait times continue to fuel the push, especially from the Canadian Medical Association, for the government to allow a parallel private system to help alleviate this issue.

Another point the CMA is pushing, related to the parallel private system, is to have the government stop funding hospitals on an annual fixed grant basis and to move to a "fee-for-service" basis to drive competition and efficiency. According to the CMA, ours is the only healthcare jurisdiction in the OECD that uses the annual grant basis.

We are beginning to see in the media and from general populace polling that people may be open to a shift to a different approach to how healthcare is delivered as long as the "universal care" concept holds. Part of this may be driven by the fact that more people are realizing that there really is not universal care today. For example, as an HP employee, I participate in a supplemental healthcare plan that provides prescription coverage (not covered by the government if you are under 65 or not in the hospital), and would allow me a semi-private hospital room instead of a wardroom. My sister-in-law is a diabetic, is stuck in a job that pays less than she would like, and is in a poor environment, but she is limited in her ability to change jobs. She needs to make sure that any new job comes with at least comparable healthcare benefits as what she has today, since she cannot afford her insulin and supplies on her own.

There is some feeling that the general population is more ready than the politicians to reform health care. Too many politicians still view the situation as needing to either be status quo or a switch to a pure "US" model, not realizing that there is room for something in between and scared that they will be at risk in the next election if they seem to be in favor of a change.

One of the most interesting "sound bite" video bits during the election campaign was when the current leader was touring a hospital and tried to shake hands with a cancer patient. The patient refused and told the premier he would not shake his hand because the government is not covering the cost of a drug treatment that he requires. One of the ways the government is controlling costs is by de-listing what drugs are covered when you are in the hospital, or not adding (or being very slow to add) new treatments to the approved list.

As mentioned in my prior update, even access to a government program can be an issue. Some feelings being expressed that the government does not actually want to solve this issue by either increasing/retaining the number of doctors graduating from our schools or by developing a faster process for certifying immigrant doctors because they can't afford the number of doctors in the system today. Adding more doctors would only increase the billings that the government would need to pay from the healthcare budget.



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