Enhancing Canadian Healthcare

When you come to a second country late in life, there’s always more to learn and everything you think you know is probably not quite right. Canadian healthcare, for example. I spent a couple of decades working in U.S. healthcare (as an academic, not as a clinician), and the comparison point was often Canadian healthcare, so I came to Canada thinking I understood it pretty well. And the irony of the fact that I couldn’t actually emigrate to Canada was because of Canadian healthcare was definitely not lost on me. But I’ve used Canadian health services and I know a few doctors and nurses who are Canadian practitioners so I thought I sort of understood it as well as a foreigner is likely to.

Nevertheless, I was surprised to receive a brochure in my Canadian mailbox the other day urging me to buy a healthcare insurance policy from something called Pacific Blue Cross. It pointed out that ‘the time to obtain health coverage is before unexpected medical expenses occur,’ and further inquired: ‘Shouldn’t we be more concerned with our health?’ I have no easy answer for that latter question, but I was surprised to think that Canadians needed to buy health insurance, other than for travel to other countries, which the Canadians I know routinely do buy. In fact, other than travel medical insurance, I was surprised to find that anybody was even selling healthcare insurance to Canadians.

But they are because, although Canadians all receive healthcare through their provincial medical plans, the provincial program (as Pacific Blue Cross points out on its web site) covers only basic things like physician visits and hospital care. Only? Basic? Aha, I said to myself. That’s what happens when you have national health insurance. People start longing for other kinds of things to be paid for by the unknown someone elses that constitute insurance pools.

What Pacific Blue Cross is offering is coverage for those ‘other ‘ things, including ‘essential and enhanced dental care.’ Enhanced dental care would be what? Apparently non-essential dental care. Including ‘vision care, physiotherapy and massage therapy, chiropractor, accidental death or dismemberment, hearing aids, hospital daily cash, emergency ambulance, prescription drugs, and out of country travel insurance.'’ Now, the standard healthcare system covers some of those things in the course of ‘medical necessity.’ For example, annual vision exams are covered for older people, but not for everybody else because there is no evidence that doing so would improve healthcare outcomes and thus they are not medically necessary.

Other things, I wasn’t so clear about, so I inquired of Canadians. It turns out that one problem they see in their healthcare is that the provincial plans actually differ as to what is covered beyond those basic doctor visits and hospital stays. Thus, I am told, an emergency ambulance might cost $50 in one province and $100 in another, but if you are in a province other than your own residence when you need an ambulance, it might cost you instead $500 (the solution to this, of course is either enhanced insurance or staying home). Some provinces may cover some kinds of physiotherapy, others may not. Prescription drugs are cheaper than in the U.S., but Canadians still pay for them, whatever their cost, and they can be very expensive in some cases. (In fact, around 2/3 of Pacific Blue Cross’ payout is for prescription drugs.) Dental care is not part of national health care at all. Further, if you are covered at one level by one province and you move to another province, your coverage changes. Finally, people whose participation in national healthcare is ensured through their employer may have different levels of coverage beyond the basic program, depending upon what the employer is offering as the enhancement package from an insurer like Pacific Blue Cross. By contrast, people who obtain their participation in national healthcare individually because they are not employed receive only the ‘basic level,’ for which they pay a relatively small quarterly payment. One person I asked who received care in this way couldn’t remember how much she paid quarterly, so it can’t be too much.

So that’s today’s education for me on Canadian healthcare. The ‘hospital daily cash’ I’m still not clear on (although Ed refers to it as ‘hospital walking around money,’ in tribute to the U.S. political season), and the ‘accidental death or dismemberment’ as a function of healthcare services entirely escapes me. At least I am pretty certain that if one is accidentally dead or dismembered, it is definitely too late to ‘be more concerned with [one’s] health.’