Ralph Nader on the superiority of Canadian Health Care

Joe Snooze wrote:Having lived and worked in health care in both countries I can tell you there are advantages and disadvantages to both systems.

The problem with the Canadian system is the long delays in treatment of non-critical conditions.

A couple of years ago my wife had a torn miniscus in her knee. She mad an appointment with an orthopedic surgeon who she saw the next week. He sent her for an MRI that she had three days later. The following week she had surgery.

In Canada the wait to see an orthopedic surgeon for this is a year. That's just the initial consultation. The wait for an MRI is six months. Then the average wait for the actual surgery is another year.
That's two and a half years with limited mobility and pain.

Long wait times ... for non-critical conditions ... depend on where you live in Canada. Some areas are slower than others. And it depends upon what the problem is too, which specialist you need. Some of them are busier than others, so for them it takes longer. Here in the Toronto area, where there is likely a higher ratio of doctors to patients, wait times can be a few months to 6 months for a consultation, then another few months until the surgery. An MRI usually takes 6 weeks to 2 months. However, my husband just recently had an MRI on his shoulder two weeks after seeing his doctor.

Now if you go to the hospital ER, all these test are done much faster. And you get to see the specialist much faster too, often right away.

Medium to long wait times for non-critical medical issues is not unheard of here in the US either---particularly if you're also exercising that highly valued "right to go to any doctor I want to go to" aspect of our current health care practice. When I switched PCPs, it was a six month wait to get an appointment with the new PCP. When I was setting up my first consult with the TMJ specialist, it was a three month wait. When my sleep doc's office called to cancel my last appointment because the *doc* could not make it, the first replacement appointment was two months out---and I was having some pretty significant problems---with pushing from my hubby, they were able to reschedule the appointment only four weeks after the date of my original appointment.

And in case anyone hasn't heard - there are Americans (and others from all over the world) coming to Canada for some procedures, consults, etc. that aren't so readily available in the U.S., and wait times are often quite good depending on the specialty involved, urgency of the case and where you live in terms of availability of services (there are only so many e.g. dedicated cancer treatment places in remote areas after all!).

Canadian here.

Given this is a CPAP forum, I'll give my experience in going through the sleep test process here in Ontario (downtown Toronto to be exact.) At the steps along the way where I had to pay something, I'll let you know with this: $$$.

I haven't been sleeping well, and had been experiencing what could be described as strange feelings in my chest -- sort of like palpitations or sudden onsets of a strange heart rhythm. After a while I grew concerned. I called my family doctor, and set an appointment for two weeks later.

On the day of the appointment, I went to his office and told the receptionist I had arrived. She asked if my home address had changed, I said no, and sat down. My health card number is already on file with them. 10 minutes later, I saw my doctor. He performed about 20 minutes of checking, etc. and typed a few things into his laptop (he uses electronic records.) He printed out a requisition form for a blood test and ECG, as well as a referral for a sleep clinic.

I immediately went to another floor in the building (it's a medical services centre) and gave the receptionist the requisition and my Ontario health card (it looks like a drivers license -- has a photo, my name, address, birth date, a magnetic stripe and a long ID number.) She swiped my card into her workstation and said sit down. 15 minutes later they took a blood test and hooked me up to an ECG. 15 minutes after that, I'm walking out the door.

I called the sleep clinic, and they scheduled me for a consultation with a doctor in two weeks. On the day of the consultation I showed up, gave my health card. The receptionist swiped my health card and 20 minutes later I was out the door with an appointment in another two weeks for an overnight sleep study.

On the night of the study, I showed up, again gave my card, swiped it again, and the next morning I was out the door. Another two weeks after that I was back for a consultation to find out I had an AHI of over 40. The doctor hands me a prescription for an APAP trial and gives me the name of a CPAP provider in the same building. I also set an appointment for a titration study at the end of the month.

I go to the CPAP provider, give them the prescription and my health card, and they hand me an APAP to take home for a month. I also went back to my family doctor to follow up on the blood test and ECG.

A month later I go for the titration study. Pulled out the health card. Leave the next morning. Two week later, show up for a follow-up appointment, again pull out the health card, and walk out with a prescription for a permanent CPAP with a setting of 9.0 cmH2O. Go back downstairs, hand in the APAP, and select an CPAP for purchase. The government will cover up to $780, but not everything. $$$ Here is the first time I have to pay out of pocket -- I had to pay the difference between the CPAP + mask cost minus the $780 covered by the government. However, my company health insurance paid 100% of the rest, except the SD card. I used my visa so I get travel points.

So at the end of this process, I had two visits to my family doctor, one visit to a blood test / ECG lab, two consultations with the sleep doctor, two overnight studies, an APAP on loan for a month, and a CPAP and mask that I had to pay for part out of pocket but was 100% reimbursed by my company except the SD card. The whole process took about three months and cost me $75 (a very expensive SD card.)

Ontario has a population of 13.5 million, which would make it the fifth largest state in the US (if it were a state.) The annual health care budget is $48 billion. That's $3,500 per year per person. Scaled up to the population of the US, that would be nearly $1.2 trillion per year.

My cost was more, due to the deductible I hadn't met yet, but my speed was a lot faster.

I confessed my sleep apnea at a regular doctor appointment. They called me the next day to schedule my sleep study. Due to travel plans, I scheduled it for 2 weeks later. They did have earlier openings. I did a split night study, had the consultation with the sleep doctor about a week and a half later, and the apap a few days after that. Overall time was about a month, but it could have been 3 weeks total if I had not been planning to travel.

I did pay almost $700 for my sleep study and 15% of my apap and supplies. I did not have to pay anything out of pocket at the time of services.

So maybe we wait a bit longer for some things, but after all, if you've been living with apnea for who knows how long, it's unlikely you'll drop dead within the weeks of waiting to get your study completed.