Canadian Health Care

leggo

The discussion on the other thread has raised some questions for me regarding our own health care system. I thought perhaps we could begin our own discussion here regarding what changes we would like to see in our country and answer some questions regarding the difference in provinces because there are obviously some of which I was not aware. I would like to find out why some are paying a nominal fee for drugs, treatment, etc. I have never paid a dime for a prescription in my life, while I was employed, nor did I ever fill out a single form for that privilege. I simply handed my employee benefits card to the pharmacist and my employer was billed automatically. Once I was diagnosed Stage lllb, I was considered "palliative" and every prescription I needed from that point on (cancer-related, or not) was paid for by my provincial health care plan, whether I was working or not. Once I was diagnosed Stage lV, I automatically received a letter stating that I was now eligible for many other things, including ensure, home-care, visits from a dietician, physio and a whole list of other things I can't even remember because I've never had to make use of them yet (knock on wood). All of this happened via my family doctor, so again, not one form for me to fill out. From what I've read on the other thread, there are Canadians in different provinces who pay a nominal fee for doctor  visits, prescriptions and treatment. I'd love to hear from women in other provinces about their situations, employed and non-employed to see how things differ from province to province. Specifically, I remember someone saying they paid $50.00 for a doctor visit with a specialist, but can't remember the details. I also remember someone saying that they were unemployed and had to pay for their prescriptions.

As for the changes I'd like to see in our own system....I only have one issue. I'm highly annoyed at the mis-use of the emergency room. I think that if you're abusing it, you should pay for it. Last week I had to take my son in for a broken foot and while were standing in triage, some idiot chickie came in with the complaint of "I think I might be pregnant". I wanted to knock her out for being so stupid. It would also be nice to see dental coverage, but given what we already get, that might be too taxing on our system so I'm willing to let that go (mainly because it's always covered through employee benefits).

I'm also curious about the wait times in different provinces, because I no longer can distingish if this is fact or fiction after reading on the other thread. The only thing I consider myself having to have "waited" for, was orthiscopic knee surgery, and that was a wait of a month. I have a feeling I waited that long only because I made a request for a specific surgeon. Other than that, I've never waited longer than a week regarding anything that has been cancer related.

pip57

gracie, are you in Ontario?  

I absolutely agree with you about the emergency room.  I think that there should be a nominal fee if you are not an emergency.  Or they should be sent to a clinic once the triage nurse has assessed the situation to be a non emergency.  I once took my daughter to  the emergency at Sick Children's Hospital in Toronto.  In the cubical next to us, there was a teenage boy who was brought in to have an itchy spot on his arm looked at.  He thought it might be poison ivy!  When asked why he didn't wait until morning to go to his doctor, he said that it was so itchy he might have trouble sleeping!

I, unfortunately, do not have private insurance coverage right now.  In the past we have been covered and it was great to have prescriptions paid for.  I have applied for Trillium to help but have not heard back yet.  I pay about $400 each month for various drugs.  But I do not mind doing that because I know I can get any care, test or treatment whenever it is necessary at no cost.  

We are so very lucky to have the system that we do in Canada.  I am sure that there are people who have encountered problems.  There always will be no matter what country you live in.  However, I do believe that most of these problems are more doctor related than a problem with the system in general.  I have had many relatives and friends needing various care at various ages and have NEVER heard of extended waiting times for any of them.  And what is this 'rationing' that we keep hearing about?

leggo

I'm in Sask. Now here is where I'm getting confused. When you say private insurance, does that mean through an employer, or through Blue Cross or something? What is Trillium?

I'm thankful every single day for our system. I'm sure I'd be on my way to homeless without it. I think we'd be hard-pressed to find someone who feels their care has been rationed. To add further to our emergency visit for the broken foot; the ER set it and told us to follow-up with our family doctor in a week to make sure it was healing correctly. He wasn't happy with how crooked his little toe looked so he referred us to a specialist. He made the call and two hours later we got a call from the specialist telling us he could meet us in the ER to have a look. He re-broke the little toe and re-set it right away, there in the ER, and did this all in between surgeries. I can't even begin to tell you how impressed I was. I almost felt stupid about being there, because the only reason it was being looked at is because it wasn't "perfectly" straight. Rationing?  I don't think so, quite the opposite. I think they may have gone a little to far to make it "perfect". I was so very annoyed with my son though, that he stuck his foot under a moving car tire!!

pip57

Yes, by private insurance I mean  any supplemental insurance that will pay for private rooms and cover some prescription costs.  We can get it through employers or on our own.  Trillium  is and organization that will help with your prescription costs according to your income.  

We figure that my daughter's care was over a million dollars.  And that was 12 years ago.  She had many hospitalizations, tests, tx, and even a bone marrow transplant.  If we had been in the States, we would never have been able to have that kind of care.  We would have had to spend time raising money instead of focusing on our daughter and our family.  I just feel so badly for the many, many women here on BC.org who are having problems getting event he basic care. 

leggo

Thank you for explaining that. I'm so very sorry about your daughter...I can't even imagine.

I'm also curious how many Canadian women have American oncologists. Both of my oncs (over a decade apart) are American. Neither one of them would ever consider going back to the States. How good can the care be in the U.S. if they both left?

bluedahlia

I'm in Ontario.  Have never paid one cent for any treatment or procedure.  I'm on LTD as I became ill while employed.  I have supplemental insurance that covers prescriptions, vision care, accupuncture, which I pay for monthly through my employer (technically, I am still employed).   I have a few more perks that came with the job, which will come in handy if I live long enough to reach retirement age. 

I see at least 7 doctors on a regular basis for my various health issues, and have never been questioned or charged anything.

covertanjou

I'm in Montreal.  I am generally happy with our health care system.  The one complaint is how long we have to wait for results compared to our US sisters.  I went for my routine mammo in mid-May, and they found two masses and calcifications.  I had an immediate magnified mammo, an ultrasound and two FNBs.  I was scheduled for a stereo biopsy two weeks later (for the calcifications), and got the results two weeks after that: LCIS/ADH.  I was then scheduled for surgery (excisional biopsy) June 24, but I had to re-schedule for personal reasons.  I had the excisional July 24, and I was told it takes 4 weeks to get the results!!  Plus, since my doctor is on holiday, I will only get the results Sept 1.  That is 5 weeks after my surgery.  I cannot express to you how hard this waiting is.  I was told that it is the summer, and that the path labs are understaffed because of holidays.  Whatever the reason, I find it difficult to accept that I have to wait  5 weeks for results when Americans get their results in days.

Sorry for the venting.  As I wrote, the care has been great, but waiting 5 weeks is intolerable.  How long did you have to wait for results? 

bluedahlia

It took 1 week for my results after core needle biopsy (which my BS did in his office) and 1 week after lumpectomy for results of the type of tumor and lymph node involvement.  This was in 2006.

pip57

I have waited from hours to a week for test results to get to me.  Some tests require that extra time but I expect most doctors have the results within days.

leggo

Covertanjou, do you think that wait time is the norm in Quebec, or was it just a matter of circumstances?

mke

I think I had to wait a while for my biopsy results in 1997 in Ontario but my surgeon warned me that the hospital was short a pathologist.  This year I was amazed when I got the results of an MRI later the same day I had it done.  I'd say most things have been about a week or so.  5 weeks is a terribly long time, I don't blame you for being upset.

I can usually get into to see my doctor in a few days and if the situation is more urgent I can use the walk-in clinic.  We have supplemental insurance for dental, drugs, etc.  We pay for part of this out of my husband's pension and the university pays the rest.  We have always been able to see a specialist relatively quickly when we needed one.

None of my doctors are American, they all trained in Ontario although some of them did residencies in the UK or US.

crazy4carrots

I waited a week for the results of the needle-guided biopsy, which was the longest week of my life!  I think the general rule is 5-7 working days but maybe longer during the summer months and Christmas break.

My onc is in St. Catharines.  Could have gone to Hamilton or Toronto (where I know some of the bc professionals), but she trained at McMaster and did 7 years residency and research at PMH/OCI so that was good enough for me.  My GP has hired a nurse practitioner who I really like (she believes in complementary medicine - hurray!) so I'm seeing her regularly.

Wait times are a form of rationing, I'm afraid, and it's just because we are experiencing a shortage of docs -- many are retiring and thanks to med school cutbacks in the early 90's (in Ontario at least) we've been feeling the effects of that for some time.  But things really are improving in that area.  My dh and I have absolutely no complaints about healthcare in the Niagara region.  We also have supplemental insurance which I carried on through UHN after I retired.  When I turn 65 in 4 years, we'll change to another form of supplemental to cover dental, chiro etc. only.

By the way, the VP of Research at PMH is American by birth, and the research there is considered so great that they've been able to recruit some of the world's best cancer specialists, from the U.S. and Europe.

bluedahlia

Linda, I love Niagara-on-the-Lake.  My SO and I go there quite often.  Do you live in the actual town or the outskirts.  We usually plan a picnic in the park there by the lake.

leggo

Linda, I know just how far-reaching the research and reputation of PMH is. I have an uncle in Germany who brought it up to me!

Another thing I find curious is how the US thinks our treatments are inferior. From everything I've read, the treatments are the same. In my circumstances however, I did find one difference. When I was diagnosed with bone mets, I was put on chemo immediately; wheras in the US, they seem to try hormonals first, always.  That is something I did bring up to my onc, because I seemed to be the only one on the board who had chemo for bone mets as a first-line treatment. Routinely, before an onc makes a decision, they discuss it with different clinics in Canada to determine if they concur. For me it was determined that since chemo had kept me cancer-free from a Stage lllb diagnosis for eleven years, it would likely be the best line of defense again with the mets and to do hormonals after that.  I suppose I'll never know if it was the right decision, but I do take much comfort in knowing that they spoke to PMH before making the final call.

Edited to add: I also love the fact that I didn't have to run around getting a second, third opinion. My onc did it for me.

leggo

After that post it dawned on me....it's really an example of how we prefer to work together for a solution. I fear that doesn't come easy in the U.S.

covertanjou

I think waiting so long is not the norm--I hope.  I think that I am a victim of circumstance: summer and my doctor is away.  All my other results took two weeks. 

mke- thank you.  I am upset.  It is so hard waiting.  I am trying to keep busy and think positively.

hrf

gracie1, thank you for starting this thread. On the "other" thread there is so much anger it jumps out at me. To your question about payment for drugs and things like private rooms, in Ontario some employers offer a benefit package - some are better than others. However, it is not a requirement so there are people who have to pay the full thing when it comes to prescription drugs or they can purchase their own package I guess. As we all know from our own experiences, those can be very costly. One Neulasta shot alone is $2,600 here. My GP charges $100 a year - administrative costs. I gladly pay it because I know she does a lot for me for which she cannot bill OHIP. I believe this is a practice that many doctors are adopting now. Also in Ontario it doesn't matter if you are Stage 3 or 4. I have a couple of friends who are stage 4 and the government does not kick in with anything extra for them. These 2 friends also did hormone treatment as their first line when they were dx with mets. For one it has worked really well. It didn't for the other and she is now on weekly chemo. I had to wait a week for biopsy results because it took that long to develop them. I am so grateful that Canadian like to look out for each other as much as we do. I think it makes for a better society as a whole. As a Canadian, I also like Obama - think he is a great leader who has the potential to really make a positve difference but his style is more progressive and many don't understand it. I'd take him in Canada any day.

crazy4carrots

The worst thing I've heard an American say about Obama's election was this: "What does that runaway slave think he's doing in our WHITE House". 

Maybe the biggest error was to aim for bi-partisanship in attempting to bring in healthcare reform.

I'm so very, very thankful I live here -- even if I'm disgusted about the current government's handling of the whole isotopes issue. Let's hope Saskatchewan can pick up the ball.

By the way, Gracie, many of the original cancer researchers at PMH/OCI came from your beautiful province -- they invented the Cobalt machine for radiotherapy that was used for years.

hrf

I read an article in either yesterday's or today's Toronto Star that said that the real issue with Obama are the racist views still held by some Americans and they just can't tolerate a Black man in the White House. I don't recall reading viciousness about any other president. Even with George W., some complained of his lack of competence but I don't recall such personal, vindictiveness against him. Sad, isn't it? I think Obama has enormous potential.

Here's something I need some Canadians advice on. I just got off the phone with my med. onc. I have started Arimidex and wanted to know about taking Zometa as well. A study has shown that Zometa can reduce the risk of recurrence by 35%. While there are potential side effects (don't we know that???), I asked about taking it. After she said there are still ongoing studies, she also said it's expensive and wanted to know if my medical insurance would cover it. Has anyone else had this conversation? Anyone Canadian women on Zometa along with the A.I.? Who pays?

Helen

leggo

Covertanjou, I sincerely hope after all that waiting you get some good news. I'll be crossing my fingers for you.

Linda, I had no idea about Sask and the Cobalt machine....I learn so much from you guys! And yes, I certainly hope that we do the right thing regarding the isotope issue. I need them...alot.

hrf, I think that's the main difference between Canada and the U.S. We gladly pay a little more because we're so grateful. I am surprised, though, that if you're Stage 4 in Ontario that it doesn't entitle you to a little extra. I suppose here in Saskatchewan, I have even a little bit more to be grateful for. As for the Zometa, my situation is different because I have bone mets. I am, however,  on an AI (femara) and a bisphosphonate (pamidronate). Zometa is not covered here. Now that they are doing ongoing clinical studies regarding using Zometa as a preventative measure, I'm wondering if you can get it through some sort of trial....or maybe the research on the topic is complete, I have no idea. Having read about all of the U.S. women getting Zometa vs. Pamidronate, I had grave concerns regarding my own situation. I was assuming Zometa was better. My onc supplied me with studies (at least 2000 pages worth), that showed that it is just as effective as Zometa....just takes longer to infuse. Because it's newer and far more expensive I think many make the assumption that it's better. I think the side effects for all of the bisphosphonates are pretty much the same. I do have some bone pain a few days after the injection (kind of like a mild flu) and I can really feel it in my bones if I don't keep up to date with my calcium supplements, which are extremely important when taking a bisphosphonate. I just hate taking pills. If you want the Zometa, I sincerely hope you can get it. Heck 35% less chance of recurrance sounds pretty good.

Edited to add: I probably should have mentioned that I can get Zometa, if I want it, but it's going to cost me, even with my husband's employee benefits. However, after reading the research (yes, I read every single page of that 2000), it just isn't worth it.

hrf

Thanks for that information, Gracie1. I think I can get Zometa if I pay for it even if my insurance won't. My onc didn't offer a clinical trial and she is not convinced all the results are fully in on Zometa. I also learned that 10% of women taking get get osteonecrosis of the jaw. It can also cause kidney damage. I'll talk to her about it some more when I see her at our next appt. My current bone density doesn't indicate a need for a bisphosphonate yet.

leggo

hrf, I'd love to hear what your onc says about it at your next appointment, if you don't mind sharing.

Maybe you guys can clue me in to something else I don't get about the U.S. I've repeatedly read the excuse that they have a population of 300 million versus our 30 million. If you have 300 million paying their fair share, doesn't it amount to the same thing regardless of population? Sadly, I'm starting to think the issue is a moot point for them. Being 11 trillion dollars in debt (and counting), distrusting each other and their government, I'm wondering how they can ever see the light of day again. As if cancer isn't sh*tty enough, you have to fight tooth and nail for treatment if you're one of the uninsured or underinsured. It sucks.

hrf

Sure, gracie1. I'll be happy to share.

I also don't understand many of the arguments put forward by the Americans and I really wonder about the future of their country. I also worry about the safety of their president.

bluedahlia

I like to be objective in my judgements, and I truly believe this president does have the best interests of the people.  I think the pre-election crap has carried on and is starting to tarnish the U.S.'s reputation, or at least what was left of it during the Bush administration.  For anyone that wants to dig deeply, it looks like many just want him to fail.  Too bad it will be at the expense of the people/country.  That does make me sad.  People must learn to look with both eyes.

Hey, I'm actually being serious.  Fancy that!

crazy4carrots

Blue, another glass of wine might help!

Just came back from a lovely night out for dinner -- with wine -- so I'm mellow.  Sort of a mini-celebration as this was about the time last year that my tastebuds returned after taxotere!!

At any rate, I do believe that if the U.S. doesn't get its act together somehow, it really is (to quote Shirley) going to hell in a handbasket, and I can only hope we don't get dragged down into the abyss. Maybe Gibbons's The Decline and Fall of the Roman Empire should be required reading for all highschool students.....

The profit motive (so dear to their hearts) is ruining healthcare, IMO -- but heck, I'm just a leftist (aka socialist) Canadian...what do I know?

Nighty-night, my fellow Canucks!

leggo

Love that Whole Foods guy's version of problems/solutions! Yikes.

delaine

Hi Everyone,

Weighing in here from Alberta. On Aug. 6 I had bi-lat mx - DX ILC, 4cm, ER+PR+, Grade 2

I had my biopsy done on June 22. I only waited a few days for an appt. with a surgeon and he ordered a lot of scans/tests - all completed in warp speed. I did wait a bit for the actual surgery date but he is very busy and did assure me that it would be fine. I wanted that surgeon so was okay with the timing.

I also had SNB procedure done (part one)  on Aug. 5

My friend was  3 weeks from mammo. to surgery with biopsy in between. That was fast. 

 We have Blue Cross coverage for  dental, incidentals and prescriptions.

I have not paid for anything out of pocket.

I am very satisfied with the health care that I received. The hosp. kept in contact with me all along the way offering counselling, a nurse navigator, etc. 

Now, my file is being transferred to the cancer clinic.  They will call me in 3 - 4 weeks to arrange oncology appts. - I do not know if this is considered a long wait or not.

Most of our close family live in Sask. Some of them have been very ill and all were treated quickly and with good out-comes. My elderly parents are well-served by the medical community in Sask. and I am so happy that cost would never be an issue for them.

No one's health care should be jeopardized by an inability to pay.

That said, something really does need to be done about the abuse of the emergency rooms - we do need to clamp down on that somehow.

I do admire the Americans for taking a long hard look, not just about  health care, at how much government involvement they want in their lives. I think we Canadians are more likely to want the government to take care of us from cradle to grave.  Not always a good thing.

 To those of you drinking wine -do you every wonder, worry, fretm whatever, about what you are eating and drinking since being diagosed with BC? I used to enjoy a glass of wine at  dinner and the odd martini on the weekend but now I question everything - wine, red meat and the list goes on and on. I hate what this disease has done to me in so many ways.

 

bluedahlia

I live every day like it's my last.  Enjoy everything without abusing.  I see things so much clearer now, and that's a good thing.

hrf

delaine, I like the idea of a nurse navigator. I think that's what has been missing from my experience. Through my supplemental insurance I actually do have a nurse navigator but she's not from my hospital so there have been times when I have had to double check and recheck or advocate for myself where it would have been nice to have a case manager. After my first dx, I really did learn not to sweat the small stuff, stay positive, modified my lifestyle - really doing the "right" things. The second dx, three and a half years later has thrown me for a loop and I now realize that this will never be behind me. I'm feeling much the same a delaine in that I hate what this disease has done to me in many ways and there are many things I have lost that I loved and that will never come back. I am trying very hard to appreciate all the good things in my life and to move forward but I am having a very difficult time.

konakat

Re. Zometa for bone mets -- I know the US gals are starting to get Zometa more than other bisphosphonates but I wouldn't worry too much about it.  I was on Aredia (another bisphosphonate for bone mets) and was switched to Zometa only because the nurses took pity on how long all my infusions took -- Aredia took about 45 min while Zometa is a speedy 15 minutes.  They suggested to my onc that I should be switched.  That was the only reason, time, nothing to do about effectiveness.  At least that's what it was for me.

Re drinking -- I have liver mets and my onc says the occasional glass of wine is just fine.  So if your liver is healthy, carry on drinking!! 

Re. that other thread -- the faulty logic (I don't get that population argument....), ignorance, or just down right lack of caring for the unfortunate is astounding.  The only mistake Obama made was grossly over-estimating the intelligence of his audience!  And the ridiculous lies that politicians just spew out!  Unbelievable!!!! 

I'm so happy that this thread started -- I need to get caught up on what's what in Canada, Ontario specifically.  I wish Ont had the stage IV perks that Sask has.  :-(

Question:  someone mentioned the cost of Neulasta.  If you get the shot in the hospital, isn't the cost covered by OHIP?

Thanks!

Elizabeth

leggo

Last night, on "King of the Hill", there was such a funny line that kind of sums up the U.S. attitude toward everyone else's health care for me. Don't know if any of you watch or not, but Hank's dog "Ladybird" couldn't conceive. Hank was on the fence about her medication and after researching he decided "If it's good enough for humans in France, I guess it's good enough for an American dog". How ironic that an animated sitcom "gets it".