Aa
To Canadian and Former Canadian members
I don’t want this to turn into a political debate. HCV Is a Health Issue that goes hand in hand with Health Care. There would be no logical reason for this thread to be deleted unless it is abused.
I would just like to hear from our Canadian members a truthful opinion about their Health Care System. Please include both Pros and Cons. I would also like to know the truth about how long it takes to see a Dr., get test/results, approval for treatment, time waiting in the lobby for emergency room visits, etc.
I don’t care to hear any conspiracy theories, only reality.
Since I keep hearing about a Health Care System compared to Canada’s, I would love to hear “from the Horses Mouth” about what we may be getting into.
So far we hear about how Great it is going to be from the one’s that are pushing for Reform and Horror Stories from the one’s against it. I would appreciate if only Canadian or former Canadian members respond. If other members use this thread for an opportunity to vent, the chances are, it will be deleted. Thank you for you honesty in advance.
Put it this way,you dont need money to go the hospital,its all paid for before you even show ip at the doorstep by the Govt system.Altho it is getting a little worse for wait times in certian situations its still pretty damn good.There is a drug progam here called Trillium that will pay for all the TX drugs,if you are working ,the co-pay is based on a % of how much you make a year...it works out to you pay 2% of you net income....for ex: my co-pay is appox $1500 fot all TX drugs.but i never even needed it because im in a trial,thereare even better places for heath care like the Nertherlands
I can't speak for Canada but from what I read on the UK Hepatitis Forum (http://www.hepcukforum.org/phpBB2/viewforum.php?f=7), the national care for Hep C seems as good as we get here in the US on private insurance plans.
I'm Canadian so your criteria applies to me. I just happen to be exhausted so I'll be back tomorrow evening...IF the thread is still here.
R, you asked pros and cons, I'll do my best to illustrate how things are here in Canada with healthcare.
The cons are that we have a distinct shortage of family doctors here. That's partly due to decisions by politicians to limit the amount of spaces in medical schools that they would fund in a certain period of time and now we have a doctor shortage.
It takes a long time to get in to see a specialist here. Six months or more.
Because testing is all paid for by the government, the government decides what treatment is covered, what tests are covered, etc. The doctors understand that they're working within a governement-funded system and will sometimes support what makes sense from that context. So you get the care that a government funded healthcare system can sustain. What you get is the same healthcare for everyone except for those who can afford to pay for their healthcare out of the country.
You have a long wait in an emerg. It takes 6-8 hours if you go in an early evening after work. That is not necessarily a bad thing. It makes people really think if they need to go see a doctor or not. They do move you along on a priority basis and do triage as quickly as possible to determine priorities. However, things get missed in a busy emerg and there are stories of course.
We have urgent care clinics where you see the doctor oncall. That helps too. So on a Saturday, you can hike into the urgent care clinic. Same kind of waiting times though. Emerg is for the really tough stuff.
Test results can take a long time to come back. Results of my first HCV PCR took two months. There are only the two (maybe three) labs in Canada that do PCR blood results so you have to wait. For persons with HCV, there is no requesting the kinds of PCR's that you want or the frequency you want them at. The government funds a set number of PCR's and I recall it's one quant PCR a year. You can have a certain number of qualitative ones while on treatment but you won't get the quant ones at 4 weeks, etc. You'll get a quant at beginning of treatment IF you haven't had a quant in the past year. (That might have changed, that's my understanding.) And then you get a quant at 12 weeks and 24. The others are qual and at certain government-decided intervals.
Not exactly true that the Trillium Drug plan funds tx drugs. And Trillium is only in Ontario, one province - like being in one state in the U.S. I'm sure the other provinces have similar drug plans. Anyway, Trillium won't fund tx drugs for anyone who is Stage 1 Grade 1 unless the doctor can make a good case for treatment at this stage. So if you decide you want treatment at this level, you are on your own. I applied and was turned down, twice. My doctor was pretty upset and appealed and they still said no. I had a conversation with my Hepatologist, very experienced, about two weeks ago after being "discharged" from all treatment and asked him about this. His opinion was that our healthcare system couldn't sustain treatment for Stage 1, Grade 1 people and that they weren't well informed enough about treatment and that new drugs were coming along. Well, what if they weren't? And when I was first looking into treatment, they weren't so close. And what about choices and where 48 weeks of treatment fit into your life? None of that matters. It's what the government decides based on financial and overall considerations. To change the system, it isn't appealing to your own insurance company, it's changing the government's decision on care for EVERYBODY, not just you.
The level of care you have is equivalent to what the governement can afford for everyone. There are long waiting times for *everything*.
People also take this for granted because they never see a bill. I worked for an answering service for a time and had the dimwits calling after hours to know if coffee was a clear fluid and if it was safe for a guy to have sex with his wife who was 8-1/2 months pregnant. The system absorbs such ludicrousness because of such idiots. I'm sure there are people going to the doctor who don't need to, simply because they can so they do.
Taxes in Canada are much higher than in the U.S. Healthcare is always one of the top issues in any election. Countless dollars have been spent on finding ways to fix the healthcare system and waiting times are one of the key issues. Not so much getting in to see the family doctor for routine issues (if you have a family doctor), it's getting in to see the specialist for anything else, going for tests and waiting for results. Those kind of waiting times. I asked a question here about how long people waited to get results of an MRI as my girlfriend was looking at a two month waiting period. People here responded they got results within a few days. Her results would determine when she had surgery. Everything slows down along the chain.
A friend of mine, his mother needed hip replacement surgery. She was in alot of pain and discomfort while she waited. It was almost criminal. But, there was no choice other than to pay for her to be treated out of the country.
cont...
The cons are that we have a distinct shortage of family doctors here. That's partly due to decisions by politicians to limit the amount of spaces in medical schools that they would fund in a certain period of time and now we have a doctor shortage.
It takes a long time to get in to see a specialist here. Six months or more.
Because testing is all paid for by the government, the government decides what treatment is covered, what tests are covered, etc. The doctors understand that they're working within a governement-funded system and will sometimes support what makes sense from that context. So you get the care that a government funded healthcare system can sustain. What you get is the same healthcare for everyone except for those who can afford to pay for their healthcare out of the country.
You have a long wait in an emerg. It takes 6-8 hours if you go in an early evening after work. That is not necessarily a bad thing. It makes people really think if they need to go see a doctor or not. They do move you along on a priority basis and do triage as quickly as possible to determine priorities. However, things get missed in a busy emerg and there are stories of course.
We have urgent care clinics where you see the doctor oncall. That helps too. So on a Saturday, you can hike into the urgent care clinic. Same kind of waiting times though. Emerg is for the really tough stuff.
Test results can take a long time to come back. Results of my first HCV PCR took two months. There are only the two (maybe three) labs in Canada that do PCR blood results so you have to wait. For persons with HCV, there is no requesting the kinds of PCR's that you want or the frequency you want them at. The government funds a set number of PCR's and I recall it's one quant PCR a year. You can have a certain number of qualitative ones while on treatment but you won't get the quant ones at 4 weeks, etc. You'll get a quant at beginning of treatment IF you haven't had a quant in the past year. (That might have changed, that's my understanding.) And then you get a quant at 12 weeks and 24. The others are qual and at certain government-decided intervals.
Not exactly true that the Trillium Drug plan funds tx drugs. And Trillium is only in Ontario, one province - like being in one state in the U.S. I'm sure the other provinces have similar drug plans. Anyway, Trillium won't fund tx drugs for anyone who is Stage 1 Grade 1 unless the doctor can make a good case for treatment at this stage. So if you decide you want treatment at this level, you are on your own. I applied and was turned down, twice. My doctor was pretty upset and appealed and they still said no. I had a conversation with my Hepatologist, very experienced, about two weeks ago after being "discharged" from all treatment and asked him about this. His opinion was that our healthcare system couldn't sustain treatment for Stage 1, Grade 1 people and that they weren't well informed enough about treatment and that new drugs were coming along. Well, what if they weren't? And when I was first looking into treatment, they weren't so close. And what about choices and where 48 weeks of treatment fit into your life? None of that matters. It's what the government decides based on financial and overall considerations. To change the system, it isn't appealing to your own insurance company, it's changing the government's decision on care for EVERYBODY, not just you.
The level of care you have is equivalent to what the governement can afford for everyone. There are long waiting times for *everything*.
People also take this for granted because they never see a bill. I worked for an answering service for a time and had the dimwits calling after hours to know if coffee was a clear fluid and if it was safe for a guy to have sex with his wife who was 8-1/2 months pregnant. The system absorbs such ludicrousness because of such idiots. I'm sure there are people going to the doctor who don't need to, simply because they can so they do.
Taxes in Canada are much higher than in the U.S. Healthcare is always one of the top issues in any election. Countless dollars have been spent on finding ways to fix the healthcare system and waiting times are one of the key issues. Not so much getting in to see the family doctor for routine issues (if you have a family doctor), it's getting in to see the specialist for anything else, going for tests and waiting for results. Those kind of waiting times. I asked a question here about how long people waited to get results of an MRI as my girlfriend was looking at a two month waiting period. People here responded they got results within a few days. Her results would determine when she had surgery. Everything slows down along the chain.
A friend of mine, his mother needed hip replacement surgery. She was in alot of pain and discomfort while she waited. It was almost criminal. But, there was no choice other than to pay for her to be treated out of the country.
cont...
The other side of the coin is this. The pros. I just had appendix surgery in December. I was in to emerg, waited six hours in excruciating pain thinking I had a flu. I was tested and determined it was appendix and the doc was concerned. That was midnight. At 3:30am I was in surgery and they found out it was perforated. I spent the next three days in hospital recovering. I never saw a bill, didn't have to even think about it. All the tests, the surgery, the hospital stay, all covered. I've been a very healthy person all my life but still, I have had cystoscopies, gave birth to three babies, had a tubal ligation, had physicals, various blood and other medical tests, a daughter who caught scarlet fever, the various things that come and go for kids throughout their childhood years.....and not once did I ever see a bill for this, R. Not once. I never worried once about how I was going to pay for my kids or myself to see a doctor. You just go. What I worried about was how I was going to pay for treatment drugs. However, there are work related benefits that people have that cover as much as 80% of drug costs and round out some of the things that publicly funded healthcare does not, like a semi private room instead of a ward room.
When I was diagnosed with Hep C, the biopsy and PCR's and doc visits even to the Hepatologists in Toronto where I eventually went for a second opinion and was treated, all covered. I never saw a bill.
However. The care I could get for my HCV was not up to what I considered acceptable. I started searching out options to get PCR's done out of the country because I couldn't get a PCR done that would tell me my viral load any more definitive than 1.3mil IU/ml. That was the HIGHEST sensitivity in CANADA at the time, not on a trial. That upset me alot to not know what my starting viral load would be so was looking for PCR sources in the U.S. at the time I got the clinical trial offered to me. In Canada, a clinical trial offers you better testing, faster results and paid drugs. A bit more reason to go on a trial in Canada as the care overall is better. We lag behind the times here. I wanted quant tests throughout my treatment, a higher sensitivity VL test and I wanted a beginning of treatment PCR and I wasn't going to get them without going outside the country.
Standard of care here moves slower as it's a whole government decision. It takes time to move from one standard to the other for a whole country on a whole slew of illnesses and we don't have as many people here in the frozen north as you do in the U.S.
I'm making it sound like it's terrible here. It's not. When I read the stories in this forum about all the stress you all go through fighting with insurance companies and doctors who bill because it makes them more money, I'm immensely grateful for my government funded healthcare even with all it's flaws.
Somewhere between the two systems is the answer. People should be able to get the care they need when the government funded system can't provide. How that happens is a huge debate here. Some say there should be a second tier of care and others say it will undermine the healthcare system we have.
I hope that helped, R. I'm by no means an expert on our healthcare system. Maybe that gives more questions than it answers. I keep thinking of things to add but I'll just leave it at that for now.
Trish
When I was diagnosed with Hep C, the biopsy and PCR's and doc visits even to the Hepatologists in Toronto where I eventually went for a second opinion and was treated, all covered. I never saw a bill.
However. The care I could get for my HCV was not up to what I considered acceptable. I started searching out options to get PCR's done out of the country because I couldn't get a PCR done that would tell me my viral load any more definitive than 1.3mil IU/ml. That was the HIGHEST sensitivity in CANADA at the time, not on a trial. That upset me alot to not know what my starting viral load would be so was looking for PCR sources in the U.S. at the time I got the clinical trial offered to me. In Canada, a clinical trial offers you better testing, faster results and paid drugs. A bit more reason to go on a trial in Canada as the care overall is better. We lag behind the times here. I wanted quant tests throughout my treatment, a higher sensitivity VL test and I wanted a beginning of treatment PCR and I wasn't going to get them without going outside the country.
Standard of care here moves slower as it's a whole government decision. It takes time to move from one standard to the other for a whole country on a whole slew of illnesses and we don't have as many people here in the frozen north as you do in the U.S.
I'm making it sound like it's terrible here. It's not. When I read the stories in this forum about all the stress you all go through fighting with insurance companies and doctors who bill because it makes them more money, I'm immensely grateful for my government funded healthcare even with all it's flaws.
Somewhere between the two systems is the answer. People should be able to get the care they need when the government funded system can't provide. How that happens is a huge debate here. Some say there should be a second tier of care and others say it will undermine the healthcare system we have.
I hope that helped, R. I'm by no means an expert on our healthcare system. Maybe that gives more questions than it answers. I keep thinking of things to add but I'll just leave it at that for now.
Trish
I am not Canadian but my son did have his appendix out 18 months ago. We went into emergency. We were not sure about whether he was covered by insurance since he was 19 and while he was waiting to be accepted into a school.....he was not currently in school and therefore we were uncertain as to whether we would have coverage. I was paying $425 per month to blue cross/ blue shield (and presently pay a nice round 500/month). In spite of the ludicrous amount I pay........ the hours that one can contact BC/BS is 8-5PM Monday through Friday. As many of you may know, medical emergencies do not always occur during business hours. (You would think that somewhere in those tallest and most beautiful buildings that the insurance companies own they could afford to have a 24 hour service line, but apparently not) : (
By way of accommodating us they bypassed the expensive imaging process and mentioned that he had all the classic signs of needing his appendix out. They recommended that he be admitted immediately into a room but that he wait until morning to have surgery so that he would have a properly refreshed surgeon, not one pulled out of bed in the middle of the night.
I asked, fine..... but when does the billing day start for a bed? Midnight, was the answer that was finally given. It is 11:30PM I mentioned. Can we wait here until after midnight? NO, was the answer. As a matter of fact we have already admitted your son into a room. And what will the cost be to us if it turns out that he is not covered by insurance? About 700 dollars for what turned out to be about 20 minutes. (it was at that point 20 till 12 midnight.
You are going to make him wait until 6 AM for his operation. Can we just show up at 6 AM? No was the answer. If you leave you will be doing so against medical advice and therefore the trip to the ER will not be covered. I asked why are you bothering to ask me anything since there is no option that is being granted?
Long story short, my son had his appendix out. The operation was a success. The appendix was not perforated. There were no complications. He was in and out as quickly as could be expected.
Cost? Just under $30 thousand dollars.
I suppose that I am fortunate that I had insurance and that he was covered. I was still responsible for 15-20% of the bill. I don't remember exactly. So my out of pocket was a mere 2 thousand dollars, give or take. I continue to pay 500 per month knowing that at some point I will treat. I cannot let my insurance lapse.....
......for in the United States many of us will not have insurance if they know that we have HCV.
*Pre existing condition* they call it.
best,
Willy
By way of accommodating us they bypassed the expensive imaging process and mentioned that he had all the classic signs of needing his appendix out. They recommended that he be admitted immediately into a room but that he wait until morning to have surgery so that he would have a properly refreshed surgeon, not one pulled out of bed in the middle of the night.
I asked, fine..... but when does the billing day start for a bed? Midnight, was the answer that was finally given. It is 11:30PM I mentioned. Can we wait here until after midnight? NO, was the answer. As a matter of fact we have already admitted your son into a room. And what will the cost be to us if it turns out that he is not covered by insurance? About 700 dollars for what turned out to be about 20 minutes. (it was at that point 20 till 12 midnight.
You are going to make him wait until 6 AM for his operation. Can we just show up at 6 AM? No was the answer. If you leave you will be doing so against medical advice and therefore the trip to the ER will not be covered. I asked why are you bothering to ask me anything since there is no option that is being granted?
Long story short, my son had his appendix out. The operation was a success. The appendix was not perforated. There were no complications. He was in and out as quickly as could be expected.
Cost? Just under $30 thousand dollars.
I suppose that I am fortunate that I had insurance and that he was covered. I was still responsible for 15-20% of the bill. I don't remember exactly. So my out of pocket was a mere 2 thousand dollars, give or take. I continue to pay 500 per month knowing that at some point I will treat. I cannot let my insurance lapse.....
......for in the United States many of us will not have insurance if they know that we have HCV.
*Pre existing condition* they call it.
best,
Willy
when I was treating, some of the people in the UK were having trouble getting procrit, which would make the treatment process very difficult if not impossible and downright dangerous for some people. I know quite a few Canadians and the only one I know with a serious chronic illness runs down to Seattle every now and then. I can't recall the specifics of why. He has MS and finally had to get on the interferon treatment for it. You take it once a month. But, this is an arguement that goes nowhere because you can find people in the US with horror stories and want nationalized health care. You can find people in Canada and other places with horror stories and hate nationalized health care.
Not all countries are the same...that's about all I can say. The problem we have in the US is the aging boomers are about to bankrupt the country. We've got big troubles looming. Being a tail end boomer, I fear by the time I need a lot of health care, it won't be good after my older siblings and their peers have devestated it.
Not all countries are the same...that's about all I can say. The problem we have in the US is the aging boomers are about to bankrupt the country. We've got big troubles looming. Being a tail end boomer, I fear by the time I need a lot of health care, it won't be good after my older siblings and their peers have devestated it.
Trish77, you made the comment that taxes are much higher in Canada. That is no longer really true, unless you are a very high income earner. When you add in the different social security taxes, taxes are often higher in the US. So personal taxes are similar, sometimes lower in Canada. With corporations, here in Alberta where I am, by 2012, corporate taxes will be 25%. In the US, it is pushing 38-40% in many States once all the different levels are added in. That's a 15% advantage. As Alberta has no sales tax, we are considerably lower taxed than any US state.
The Canadian health care system is not perfect, in particular it does not allow choice of private health care. But, it offers universal health care. The US is probably the only developed country in the world that does not have universal health care - it really is an embarrassment for a country that is supposed to be the richest in the world
The Canadian health care system is not perfect, in particular it does not allow choice of private health care. But, it offers universal health care. The US is probably the only developed country in the world that does not have universal health care - it really is an embarrassment for a country that is supposed to be the richest in the world
How do you think they got rich and who has all the money in their back pocket???
I have been following this thread closely (is that a word like stupidly?) because I want the truth and I appreciate every post. Let’s keep the opinions bridled. We have debt that someone will have to pay, not money.
l-horn, my guess would be that this person goes to Seattle for the same reason I was going to go to NY. For the things that either take too long here or are not available here because the government won't cover them. Maybe drugs that aren't approved yet in Canada. Maybe tests where results come back just so much faster. If you can wait here, great. If not, then you look for alternatives.
moa, possibly and probably you are right about the taxes having adjusted. There was an article in Macleans not so long ago - I'll have to dig it out - that indicated Canada was ahead of the U.S. these days in practically every area including quality of life. I can imagine they compared taxes also.
moa, possibly and probably you are right about the taxes having adjusted. There was an article in Macleans not so long ago - I'll have to dig it out - that indicated Canada was ahead of the U.S. these days in practically every area including quality of life. I can imagine they compared taxes also.
Question: As a stage 4 with cirrhosis, looks like I may have finally cleared after the 3rd tox. Would I have had the opportunity to treat that 3rd time? Or even the 2nd? on the Canadian plan? Thanks.
gauf: congratulations!! look like third time's a charm.
trish: thanks for taking the time to post a balanced and informative summary. Gauf brings up a good question - how are marginal treatment decisions handled - high cost vs relatively low likelihood of success. Similar hcv-related questions might be what if one wants to continue with detectable vl at 24w, as some here have chosen to. For cancer it might be availability of chemo for an aggressive form like small-cell lung. Who sits on the review boards that make those decisions/appeals and what guidelines do they follow?
Your statement " So you get the care that a government funded healthcare system can sustain." summarizes it well. However is going outside the country the only option? Is it not possible, if you can afford it, to supplement public coverage with a private insurance, paid for by individual or employer? For example, my mother lives in Europe and receives generally very good government-administered health care but also carries an insurance policy to cover additional costs.
trish: thanks for taking the time to post a balanced and informative summary. Gauf brings up a good question - how are marginal treatment decisions handled - high cost vs relatively low likelihood of success. Similar hcv-related questions might be what if one wants to continue with detectable vl at 24w, as some here have chosen to. For cancer it might be availability of chemo for an aggressive form like small-cell lung. Who sits on the review boards that make those decisions/appeals and what guidelines do they follow?
Your statement " So you get the care that a government funded healthcare system can sustain." summarizes it well. However is going outside the country the only option? Is it not possible, if you can afford it, to supplement public coverage with a private insurance, paid for by individual or employer? For example, my mother lives in Europe and receives generally very good government-administered health care but also carries an insurance policy to cover additional costs.
I'll do my best to answer you.
Gauf - two components to treatment, right? The drugs used and the care delivered. Drugs are not universal here, healthcare is. Drug plan is dependent on income and is our 2nd largest healthcare expense. Both care delivered and drugs approved are government decisions and both are made at provincial levels. The Government of Canada gives money to the provinces under the criteria that the care delivered will be accessible, universal and non-discriminatory. The provinces then decide where those dollars go best. There is some collusion between provinces to make such decisions so that they're in step with each other, mostly for their own sake.
You would have had the opportunity to treat all three times, I believe. What you would not have had is approval for the drugs for treatment beyond the first time and you might have had to wait until you were stage 2 to get approval to begin with. Having said that, if you were willing and able to pay for your own drugs, you would have been able to proceed for the most part.
What you would NOT have had is the flexibility you would potentially have in the U.S. when it comes to frequency of testing and type of testing, length of time to wait for test results and possibly the treatment regimen you wanted to follow. I do not know if you would have been able to treat at the intervals that YOU wanted. The standard treatment regimen is decided by a body of health professionals. It's as current as they are in making those decisions and making changes to the protocols. I find them lagging. Case in point again is the fact that the highest sensitivity PCR in Canada when I entered treatment in 2007 (after waiting a full year to get in to see the specialist and then get results of a quantitative PCR) was 1.3mil IU/ml. Gauf, that was in 2007. Can you imagine that being the highest sensitivity PCR available IN CANADA at that point in time, considering what was available in the U.S.??? I think a year (or less) after that, they have now added a new higher sensitivity test. There are only two labs in Canada that process PCR's and they are both publicly funded. Any private labs would not be able to provide their services privately, they'd be contracted by the government and paid by them to provide their services privately but in accordance with the guidelines of our healthcare system.
Test results are everything going through treatment, mais oui? You would have gotten mostly qual PCR's and quants at beginning (maybe, depending when your most recent one was) 12 weeks and 24 weeks and at 48 weeks. I don't think you would have gotten 4, 12 and 24 post EOT tests. I was on a trial so things were different for me. I know it's been excruciating waiting for the results of my fellow heppers who are not on trials and wait months for results instead of the week or less I had to wait.
If I wanted procrit or neupogen and I had to count on the provincial drug care plan to pay for it, it would take weeks to approve at minimum. If my first treatment had failed and I had to do it again, I think I would get the doc to submit approval for procrit and neupogen (eprex and neupogen here) upfront so that we were ready to go on a moment's notice if required but I don't know if that is possible. I don't see why not, I just don't know. Now I'll have to find out.
Having said that, my biopsy was covered, my doc visits were all covered, from the family physician, local GI, Toronto hepatologists, all the tests ran by each along the way....all of it. I never saw a bill. We did have to fight for approval for treatment drugs and got denied twice. Then I went for the second opinion because my GI wanted to treat based on viral load and without a biopsy. I wanted more expertise than that. My first Toronto doc was willing to fight yet again for drugs for me at Stage 1 because I was *mentally ready* to do treatment. Then I got into the trial.
Does that help at all? If it gives more questions than it answers, I'll be happy to check with my fellow heppers around here. What my overall impression is...is that we lag behind and the treatment is not what I would like it to be. You would have more flexibility and superior care in the U.S. IF you had the right combination of doctor and insurance company.
Here...my care would be adequate for the most part and again, according to what a publicly funded healthcare system can sustain.
Trish
Gauf - two components to treatment, right? The drugs used and the care delivered. Drugs are not universal here, healthcare is. Drug plan is dependent on income and is our 2nd largest healthcare expense. Both care delivered and drugs approved are government decisions and both are made at provincial levels. The Government of Canada gives money to the provinces under the criteria that the care delivered will be accessible, universal and non-discriminatory. The provinces then decide where those dollars go best. There is some collusion between provinces to make such decisions so that they're in step with each other, mostly for their own sake.
You would have had the opportunity to treat all three times, I believe. What you would not have had is approval for the drugs for treatment beyond the first time and you might have had to wait until you were stage 2 to get approval to begin with. Having said that, if you were willing and able to pay for your own drugs, you would have been able to proceed for the most part.
What you would NOT have had is the flexibility you would potentially have in the U.S. when it comes to frequency of testing and type of testing, length of time to wait for test results and possibly the treatment regimen you wanted to follow. I do not know if you would have been able to treat at the intervals that YOU wanted. The standard treatment regimen is decided by a body of health professionals. It's as current as they are in making those decisions and making changes to the protocols. I find them lagging. Case in point again is the fact that the highest sensitivity PCR in Canada when I entered treatment in 2007 (after waiting a full year to get in to see the specialist and then get results of a quantitative PCR) was 1.3mil IU/ml. Gauf, that was in 2007. Can you imagine that being the highest sensitivity PCR available IN CANADA at that point in time, considering what was available in the U.S.??? I think a year (or less) after that, they have now added a new higher sensitivity test. There are only two labs in Canada that process PCR's and they are both publicly funded. Any private labs would not be able to provide their services privately, they'd be contracted by the government and paid by them to provide their services privately but in accordance with the guidelines of our healthcare system.
Test results are everything going through treatment, mais oui? You would have gotten mostly qual PCR's and quants at beginning (maybe, depending when your most recent one was) 12 weeks and 24 weeks and at 48 weeks. I don't think you would have gotten 4, 12 and 24 post EOT tests. I was on a trial so things were different for me. I know it's been excruciating waiting for the results of my fellow heppers who are not on trials and wait months for results instead of the week or less I had to wait.
If I wanted procrit or neupogen and I had to count on the provincial drug care plan to pay for it, it would take weeks to approve at minimum. If my first treatment had failed and I had to do it again, I think I would get the doc to submit approval for procrit and neupogen (eprex and neupogen here) upfront so that we were ready to go on a moment's notice if required but I don't know if that is possible. I don't see why not, I just don't know. Now I'll have to find out.
Having said that, my biopsy was covered, my doc visits were all covered, from the family physician, local GI, Toronto hepatologists, all the tests ran by each along the way....all of it. I never saw a bill. We did have to fight for approval for treatment drugs and got denied twice. Then I went for the second opinion because my GI wanted to treat based on viral load and without a biopsy. I wanted more expertise than that. My first Toronto doc was willing to fight yet again for drugs for me at Stage 1 because I was *mentally ready* to do treatment. Then I got into the trial.
Does that help at all? If it gives more questions than it answers, I'll be happy to check with my fellow heppers around here. What my overall impression is...is that we lag behind and the treatment is not what I would like it to be. You would have more flexibility and superior care in the U.S. IF you had the right combination of doctor and insurance company.
Here...my care would be adequate for the most part and again, according to what a publicly funded healthcare system can sustain.
Trish
"when I entered treatment in 2007" - that should not read when I entered treatment...it should read when I entered into care for my HCV. I went into treatment on the last day of Feb in a leapyear in 2008. SVR April 2009 after 34 weeks on the cancelled R1626 PhaseIIb trial as a G1 treatment naive Stage 1 Grade 1.
Will try to answer YOUR questions as best I can.
Bear with me for some preliminary explanation on how care is delivered here:
First, understand that the Government of Canada gives money to the provinces, as long as they follow the overall philosophy and policy of the universal health care system - available regardless where you are in Canada when you require treatment, universal and non-discriminatory based on who you are and how much money you have and no extra user fees to be charged for things that the government covers. There are fees for things like a doctor's letter, etc. The provinces administer health care and make decisions. You get some differences from province to province on what is funded and what is not. Essentially, it's similar but then there is Quebec which is the ONLY province in Canada to allow private health care and that is only because a patient and a doctor took it all the way to the Supreme Court of Canada and the patient won the right to receive private health care and the doctor won the right to offer it, thereby making it available in all of Quebec.. (Qu'el surprise, Quebec is "a nation within a nation".)
"Gauf brings up a good question - how are marginal treatment decisions handled - high cost vs relatively low likelihood of success. Similar hcv-related questions might be what if one wants to continue with detectable vl at 24w, as some here have chosen to. For cancer it might be availability of chemo for an aggressive form like small-cell lung. Who sits on the review boards that make those decisions/appeals and what guidelines do they follow? "
Any decisions here are made with keeping the cost in mind. Having said that, if the doc feels it's worthwhile, he / she will proceed. They may be hampered by tests or procedures that the government will not cover. The doctor themself may have an opinion that, in a publicly funded healthcare system, the approach is not responsible. If someone wanted to go beyond 24 weeks, that would likely not happen here. It's happened for the one woman I know but not because it was a knowledgeable decision between her and her doctor. It was a lack of knowledge on his part that had her extending treatment longer than she needed when she was still detectable at 24 weeks and he continued. For the most part, protocol would be followed here. That protocol is decided by committees of doctors and advisors. Decisions are made based on what is good medical practice and what the system can afford. So, yes - there is a certain amount of decision-making that takes into account the balance of risk vs. the cost to determine the standard of care for a country full of people on a broad range of health issues.
Having said that, the impression I get is that where we lack is flexibility, waiting times and keeping up with current trends. Waiting times are absolutely terrible. If you want to see funding for a specific health issue in specific ways, you need to lobby the government to change it for everyone. There is no individual appeal to the insurance company you're with, the government IS the insurance company so to speak.
cont....
Bear with me for some preliminary explanation on how care is delivered here:
First, understand that the Government of Canada gives money to the provinces, as long as they follow the overall philosophy and policy of the universal health care system - available regardless where you are in Canada when you require treatment, universal and non-discriminatory based on who you are and how much money you have and no extra user fees to be charged for things that the government covers. There are fees for things like a doctor's letter, etc. The provinces administer health care and make decisions. You get some differences from province to province on what is funded and what is not. Essentially, it's similar but then there is Quebec which is the ONLY province in Canada to allow private health care and that is only because a patient and a doctor took it all the way to the Supreme Court of Canada and the patient won the right to receive private health care and the doctor won the right to offer it, thereby making it available in all of Quebec.. (Qu'el surprise, Quebec is "a nation within a nation".)
"Gauf brings up a good question - how are marginal treatment decisions handled - high cost vs relatively low likelihood of success. Similar hcv-related questions might be what if one wants to continue with detectable vl at 24w, as some here have chosen to. For cancer it might be availability of chemo for an aggressive form like small-cell lung. Who sits on the review boards that make those decisions/appeals and what guidelines do they follow? "
Any decisions here are made with keeping the cost in mind. Having said that, if the doc feels it's worthwhile, he / she will proceed. They may be hampered by tests or procedures that the government will not cover. The doctor themself may have an opinion that, in a publicly funded healthcare system, the approach is not responsible. If someone wanted to go beyond 24 weeks, that would likely not happen here. It's happened for the one woman I know but not because it was a knowledgeable decision between her and her doctor. It was a lack of knowledge on his part that had her extending treatment longer than she needed when she was still detectable at 24 weeks and he continued. For the most part, protocol would be followed here. That protocol is decided by committees of doctors and advisors. Decisions are made based on what is good medical practice and what the system can afford. So, yes - there is a certain amount of decision-making that takes into account the balance of risk vs. the cost to determine the standard of care for a country full of people on a broad range of health issues.
Having said that, the impression I get is that where we lack is flexibility, waiting times and keeping up with current trends. Waiting times are absolutely terrible. If you want to see funding for a specific health issue in specific ways, you need to lobby the government to change it for everyone. There is no individual appeal to the insurance company you're with, the government IS the insurance company so to speak.
cont....
cont..
Willing: "Your statement " So you get the care that a government funded healthcare system can sustain." summarizes it well. However is going outside the country the only option? Is it not possible, if you can afford it, to supplement public coverage with a private insurance, paid for by individual or employer? For example, my mother lives in Europe and receives generally very good government-administered health care but also carries an insurance policy to cover additional costs."
In the U.S., if you can pay for it, you can have it. In Canada, you cannot pay for it. Private health care here is against the law. Going out of the country is pretty much the only option. You get benefits that cover extras like a private or semi-private room, a percentage of your drug costs, in Ontario perhaps your optometrist visit will be covered by your benefits as Ontario removed coverage for an optometrist assessment for glasses - things like that. But if you want to pay for or have the care that the government does not provide, there is no mechanism for that and, as I said, it is against the law for anyone to provide provide health care here in this country. The only exception is Quebec - I'm going to include a link for you that contains a story about the lawsuit brought in Quebec by a man who had to wait interminably long for hip replacement surgery and the doctor who fought for the right to provide private care. The Supreme Court of Canada sided with the patient and the doctor so Quebec is the only province where private health care is available. I don't actually know if this is true as the government there planned to appeal of course and I don't know the status (maybe a Quebecer or more knowledgeable Canadian can kick in here.)
In this story is a good link that explains the difference between private and public health care in Canada. In a nutshell however, as private as it gets is that you may get your ambulance paid for, a semi-private room, your optometrist appointment paid for..peripheral things like that. Actual care and treatment, no. It has to be the same for everyone and we do not currently allow what is referred to as a two-tiered system here - where those that have the money to pay for better care can get it here. If you have the money, you're going out of the country and private clinics that provide treatment outside of the publicly funded healthcare system are against the law.
You may find this interesting reading:
The battle in Quebec for private health care:
http://www.cbc.ca/canada/story/2005/06/09/newscoc-health050609.html
The link within the article that explains Public vs. Private healthcare in Canada:
http://www.cbc.ca/news/background/healthcare/public_vs_private.html
I must say here though ... while it's *important* to have your eyes open and know what you're not getting with universal healthcare, it's also important to know what you DO get and I hope the U.S. finds a good balance between the two.
I happen to have been particularly blessed to have raised three children who seem to have inherited their mother's healthy constitution. There wasn't really anything serious that my kids had growing up - there was a tonsilectomy my daughter had at age 4 and then the regular childhood ailments along the way. Not even a broken bone, I don't think. Partway through their childhood I became a single parent working two jobs to support them. I didn't fit into the criteria of being covered by the social assistance program. Money was really really tight. I cannot even begin to imagine how I would have paid for their doctor visits and prescriptions for even routine things if I had no insurance. I almost always worked a job where I had benefits that covered most of their drugs and dental. If I was a family where there were health issues to manage...I shudder to think how I would have managed to pay for that. I guess I would have ended up with what is social care in the U.S. In Canada, the care is the same quality for everyone regardless of income. And I have to say, I really like that. We get very frustrated with the inefficiencies in the system but there is no having to settle for the care your income will provide you here (except for those that can afford to go out of the country and the world will always have such things.) You get to see the very best doctor you can manage to get an appointment with regardless of income. We do have good care here. It's just not perfect.
The kind of healthcare we have here may not appeal as much to those who can afford to provide for themselves differently. But life isn't all about ourselves, right? We're a global village. Just take from our system what you can learn and make yours a good one.
Hope that helps somewhat??
(*always* nice to see your name up there, Willing...hope you are well. :)
Trish
Willing: "Your statement " So you get the care that a government funded healthcare system can sustain." summarizes it well. However is going outside the country the only option? Is it not possible, if you can afford it, to supplement public coverage with a private insurance, paid for by individual or employer? For example, my mother lives in Europe and receives generally very good government-administered health care but also carries an insurance policy to cover additional costs."
In the U.S., if you can pay for it, you can have it. In Canada, you cannot pay for it. Private health care here is against the law. Going out of the country is pretty much the only option. You get benefits that cover extras like a private or semi-private room, a percentage of your drug costs, in Ontario perhaps your optometrist visit will be covered by your benefits as Ontario removed coverage for an optometrist assessment for glasses - things like that. But if you want to pay for or have the care that the government does not provide, there is no mechanism for that and, as I said, it is against the law for anyone to provide provide health care here in this country. The only exception is Quebec - I'm going to include a link for you that contains a story about the lawsuit brought in Quebec by a man who had to wait interminably long for hip replacement surgery and the doctor who fought for the right to provide private care. The Supreme Court of Canada sided with the patient and the doctor so Quebec is the only province where private health care is available. I don't actually know if this is true as the government there planned to appeal of course and I don't know the status (maybe a Quebecer or more knowledgeable Canadian can kick in here.)
In this story is a good link that explains the difference between private and public health care in Canada. In a nutshell however, as private as it gets is that you may get your ambulance paid for, a semi-private room, your optometrist appointment paid for..peripheral things like that. Actual care and treatment, no. It has to be the same for everyone and we do not currently allow what is referred to as a two-tiered system here - where those that have the money to pay for better care can get it here. If you have the money, you're going out of the country and private clinics that provide treatment outside of the publicly funded healthcare system are against the law.
You may find this interesting reading:
The battle in Quebec for private health care:
http://www.cbc.ca/canada/story/2005/06/09/newscoc-health050609.html
The link within the article that explains Public vs. Private healthcare in Canada:
http://www.cbc.ca/news/background/healthcare/public_vs_private.html
I must say here though ... while it's *important* to have your eyes open and know what you're not getting with universal healthcare, it's also important to know what you DO get and I hope the U.S. finds a good balance between the two.
I happen to have been particularly blessed to have raised three children who seem to have inherited their mother's healthy constitution. There wasn't really anything serious that my kids had growing up - there was a tonsilectomy my daughter had at age 4 and then the regular childhood ailments along the way. Not even a broken bone, I don't think. Partway through their childhood I became a single parent working two jobs to support them. I didn't fit into the criteria of being covered by the social assistance program. Money was really really tight. I cannot even begin to imagine how I would have paid for their doctor visits and prescriptions for even routine things if I had no insurance. I almost always worked a job where I had benefits that covered most of their drugs and dental. If I was a family where there were health issues to manage...I shudder to think how I would have managed to pay for that. I guess I would have ended up with what is social care in the U.S. In Canada, the care is the same quality for everyone regardless of income. And I have to say, I really like that. We get very frustrated with the inefficiencies in the system but there is no having to settle for the care your income will provide you here (except for those that can afford to go out of the country and the world will always have such things.) You get to see the very best doctor you can manage to get an appointment with regardless of income. We do have good care here. It's just not perfect.
The kind of healthcare we have here may not appeal as much to those who can afford to provide for themselves differently. But life isn't all about ourselves, right? We're a global village. Just take from our system what you can learn and make yours a good one.
Hope that helps somewhat??
(*always* nice to see your name up there, Willing...hope you are well. :)
Trish
Trish, thank you so much for your time. Please (along with others) continue to share the truth as you see it, concerning Health Care in Canada. You guys (notice I didn’t say ya’ll. LOL) are about all we have to go on. So far we haven’t seen an actual plan.
"I don't want it, no way "
NO way? Not even in SOME way? In what ways do you think your system needs to be improved? I'm curious, because as I've been going through treatment and reading all the battles the people here go through with doctors and insurance companies, despite the inefficiencies in my own system, I'm grateful I don't have to battle with that. Your co-pay amounts are significant and would cause me serious financial issues. Willy mentioned he pays $500 a month??? I can't even conceive of having a $500/month bill for anything other than mortgage, let alone my healthcare just in case I get sick. I know it comes out of our taxes here and is an invisible bill in some ways but certainly it's not something I have to worry about every month if I can pay it or not.
In the U.S. it seems the level of health care you get is dependent on the employer you have and how much you're able to pay per month. Some insurance companies are better than others, it seems, in your system. In Canada, your health care is guaranteed regardless of your employer and everyone has equal access. What happens if you lose your job?
I'm not sure I'd want to live with that constant uncertainty and pressure when it comes to something as fundamental as healthcare, particularly as a parent and when we're now the sandwich generation, taking care of children and taking care of aging parents, etc.
So again, I ask you...in what ways do you think your system needs to be improved? Because if it was a direct swap between yours and mine as they are, I'd take mine in a heartbeat.
NO way? Not even in SOME way? In what ways do you think your system needs to be improved? I'm curious, because as I've been going through treatment and reading all the battles the people here go through with doctors and insurance companies, despite the inefficiencies in my own system, I'm grateful I don't have to battle with that. Your co-pay amounts are significant and would cause me serious financial issues. Willy mentioned he pays $500 a month??? I can't even conceive of having a $500/month bill for anything other than mortgage, let alone my healthcare just in case I get sick. I know it comes out of our taxes here and is an invisible bill in some ways but certainly it's not something I have to worry about every month if I can pay it or not.
In the U.S. it seems the level of health care you get is dependent on the employer you have and how much you're able to pay per month. Some insurance companies are better than others, it seems, in your system. In Canada, your health care is guaranteed regardless of your employer and everyone has equal access. What happens if you lose your job?
I'm not sure I'd want to live with that constant uncertainty and pressure when it comes to something as fundamental as healthcare, particularly as a parent and when we're now the sandwich generation, taking care of children and taking care of aging parents, etc.
So again, I ask you...in what ways do you think your system needs to be improved? Because if it was a direct swap between yours and mine as they are, I'd take mine in a heartbeat.
My main concern is quality, who will really be paying the tab, and jumping into this thing with so many unanswered questions.
You would think by now we would learn from our mistakes. Jumping into things prematurely has done little more than pour salt in wounds. Whether it is Bush with Iraq or Obama’s Stimulus that resulted in little more than Bonuses and Vacations.
I see this like a Parent that promised his children a Pony for Christmas. At Christmas Eve the parent realizes, I have to get a Pony. He goes out to buys a pony with the attitude a pony is a pony and I promised them I would get them one. Christmas morning arrives and a raggedy, barely rideable pony is presented.
Later the question is asked, where will the pony be kept, who is going to pay for the stable, who is going to pay for the feed, who is going to pay for the Vet. Bills? The parent answers, there are several people all over the country that can afford pastures, stables, feed, and have veterinarians to care for their horses. When they can no longer afford to take care of everyone’s ponies, we will think of something else. Until that day comes rejoice that I followed through with my promise and got you the pony I promised, even though it was not the pony you expected.
You would think by now we would learn from our mistakes. Jumping into things prematurely has done little more than pour salt in wounds. Whether it is Bush with Iraq or Obama’s Stimulus that resulted in little more than Bonuses and Vacations.
I see this like a Parent that promised his children a Pony for Christmas. At Christmas Eve the parent realizes, I have to get a Pony. He goes out to buys a pony with the attitude a pony is a pony and I promised them I would get them one. Christmas morning arrives and a raggedy, barely rideable pony is presented.
Later the question is asked, where will the pony be kept, who is going to pay for the stable, who is going to pay for the feed, who is going to pay for the Vet. Bills? The parent answers, there are several people all over the country that can afford pastures, stables, feed, and have veterinarians to care for their horses. When they can no longer afford to take care of everyone’s ponies, we will think of something else. Until that day comes rejoice that I followed through with my promise and got you the pony I promised, even though it was not the pony you expected.
Since this thread has crossed the Medhelp line anyway... I think that the pony analogy is just a little bit off. Over the years we have discussed the female inflatable 'aid'. You know who I'm talkin about out there. You hear wonderful things about her (it). Shapely, dosen't ask for much, puts up with bad jokes and bad gas. But in the end, you just get screwed and are left with a limp deflated pile of useless carcass that you are embarassed about and it still shows up on your credit card bill the following month. Time to take matters in to your own hands.
Oh man, The Health Care and The Female Inflatable Aid Analogy.
Sorry FLguy but I am trying to block that one out of my mind. The more I think about it the worse it gets.
Sorry FLguy but I am trying to block that one out of my mind. The more I think about it the worse it gets.
whoa! your ability to write in depth always amazes me, Many thanks for the interesting replies and links. The concept that private health care should be illegal in a capitalist society takes some getting used to. In my non-existent free-time I'd like to read more about what led to the adoption of that view.
A couple more questions if you have the time. Is there a generally accepted explanation for the long lead times for specialist appointments (eg relative to the US do fewer doctors specialize or do more people, who might otherwise not have access, see specialists?). The link you provided indicated fees for say private hospital rooms or botox injections are standard - but apparently that's not the case for MRIs or patient-ordered PCRs. Is there a move towards widening or narrowing the fee-based part of the system?
Since Flguy's inflatable aid analogy has probably already pushed this thread over the edge I'll risk more censorship - I agree completely: notwithstanding the considerable problems you list, it looks like a very good system.
"Lawyers for the federal government argued the court should not interfere with the health-care system, considered "one of Canada's finest achievements and a powerful symbol of the national identity.""
I wonder who would consider the current US system one of our finest achievements, etc. Still the interesting about a democracy is people get to choose what they want - we should find out before too long...
A couple more questions if you have the time. Is there a generally accepted explanation for the long lead times for specialist appointments (eg relative to the US do fewer doctors specialize or do more people, who might otherwise not have access, see specialists?). The link you provided indicated fees for say private hospital rooms or botox injections are standard - but apparently that's not the case for MRIs or patient-ordered PCRs. Is there a move towards widening or narrowing the fee-based part of the system?
Since Flguy's inflatable aid analogy has probably already pushed this thread over the edge I'll risk more censorship - I agree completely: notwithstanding the considerable problems you list, it looks like a very good system.
"Lawyers for the federal government argued the court should not interfere with the health-care system, considered "one of Canada's finest achievements and a powerful symbol of the national identity.""
I wonder who would consider the current US system one of our finest achievements, etc. Still the interesting about a democracy is people get to choose what they want - we should find out before too long...
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