Monday, December 29, 2008

Our first experience with the Canadian Healthcare System

So, on December 7, Sarah broke her arm while making a fabulous save as a goalie in our soccer game. Immediately after the game we took off to the Emergency Room at a local hospital to get our first taste of the sometimes praised and often criticized Canadian healthcare system.

It was a Sunday night, and we arrived around 6 pm. Sarah was in some pain, but she was by no means crying nor were there bones sticking out of her skin. In fact, we weren’t sure that her arm was broken, but from the swelling and the pain, we suspected as much. The hospital emergency waiting room was quite full. I had heard stories of long, often eight-hour, waits for treatment. I was expecting the worst.

As soon as we walked in the door, Sarah used a kiosk to sign in and print a number to see the triage nurse. We were there only about five minutes before she was seen by the triage nurse. The nurse took Sarah’s blood pressure, checked her oxygen levels, and said that it would be a fairly long wait but that she would get in for an x-ray right away to save time later.

About twenty minutes after this, Sarah was called into radiology and had her x-rays done. After this, we were sent back to the main waiting room. Then began the long wait. By this time, it was about 7 pm. The waiting room was still quite busy, although there was no one vomiting, bleeding, or otherwise dying. One pregnant woman was clearly in great discomfort and crying and rocking in her seat, and I was happy so see that they came to get her from the waiting room fairly quickly.

In the two hours that followed, we had lots of time to watch “Friends” episodes on the waiting room tv as well as observe the other Canadians (presumably) who were there for treatment. Everyone was very quiet and patient. Most of the people had been there at least as long as us. Not once did I observe anyone go up to the ER desk and complain about the wait or ask for an estimated time frame. A mother and her son worked on crossword puzzles in one corner. In another, couples quietly chatted. One young lady came in and signed in for treatment with her Tim Horton’s take-out in hand. Sarah just cradled her arm and winced occasionally from the pain. I continually braced myself for a rant to the triage nurse or the registration clerks about the long wait, but that didn’t happen.

I was also able to overhear the odd conversation revealing clues to the reasons the others were at the ER. A few were inexplicably dizzy. Another felt she was having an allergic reaction. One other thought she might have a broken collar bone. Despite these complaints, no one was falling on the floor, showing obvious signs of hives or trouble breathing, or convulsing with pain. Around 9 pm, several of us were called into the treatment area where we waited another 20 minutes or so. Eventually, Sarah and were brought into a treatment room where we were immediately seen by a nurse. Shortly thereafter a doctor arrived and let us know that, yes, indeed, Sarah’s arm was broken, or at least cracked. She was given some very strong pain killers and a cast. After another hour or so, she was still in pain and so was given more pain killers. During this time, I was also able to listen in on more conversations about dizziness and “just not feeling right” as well as supposed allergic reactions that did not seem to cause the ER physicians great concern.

A little past midnight, Sarah was sent on her way with a cast, a prescription for pain pills, and a temporary sling. We were also informed that she would have an appointment with an orthopaedic surgeon, and we’d be contacted with the details.

Okay, so that’s not too exciting of a story. But let me draw some comparisons and differentiations between what we experienced here and what we would have experienced in the US. Americans (and Canadians) are quick to point out the problems with the Canadian healthcare system, particularly in terms of wait times—wait times in the ER, wait times for MRIs, wait times to see a specialist, etc. Having been to emergency rooms in several cities in Michigan and Illinois myself, I know that when it’s 5 am and I’m in excruciating pain from a kidney stone, I have usually directed Sarah to take me to, not the closest ER, but the one where I expected the shortest wait. So, even in the healthcare utopia of the United States, ER waiting times were enough of a concern that I would have Sarah drive me an extra fifteen minutes, while I’m almost passing out from pain, to a hospital known to be less busy. Also, I have, on several occasions in the US, gotten through triage, past the waiting room, and into a treatment area, and even to a bed and still waited over a half hour for pain medication and over an hour to see a doctor. The last time I visited a Michigan ER in January of 2008 with a kidney stone, I was in so much pain that I was yelling and crying and rolling around in the hospital bed with no pain medication or visit from a doctor. It went on so long that after about twenty minutes of this, a security guard actually came in to see what the noise was.

I’m not saying the treatment in Canadian emergency rooms are better or worse, but I am saying that waiting is an issue in the US as well. You may just wait in a treatment room rather than a waiting room. After all, a common marketing tactic for US hospitals is to brag about their ER waiting times—often they claim that you will not wait more than an hour before receiving treatment. Let me tell you—depending on your emergency, an hour can still be a really long time.

The next day we had a call from the orthopaedic surgeon’s office, and she had an appointment two days after that. The doctor took off her cast, gave her a sling and more pain pills, and sent her on her way with an appointment for two weeks later. Apparently because the bone was not broken too badly, a cast wasn’t necessary.

Taking everything into consideration, our ER visit probably ended up lasting about two hours longer in Canada than it would have in the US. However, when comparing the cost of our time to the monetary cost we would have faced in the US, the two hours was probably worth it.

Here is my estimation of what Sarah’s broken arm would have cost in the US.

ER visit co-pay $100
Pain medication prescription co-payments $15 x 2=$30
Specialist visit co-pay $25 x 4=$100

WAIT—stop adding. This calculation is irrelevant because. . . .
we would have annual coinsurance (deductible) of $1500! So, we’d be paying the whole amount of the ER visit, up to $1500 plus 20% of anything beyond that. Oh, and prescription and doctor visit co-payments don’t count towards the $1500 coinsurance.

Let’s try again.

ER visit $500
Pain medication prescription co-payments $15 x 2=30
Specialist visit co-pay $25 x 4=$100
Arm sling $10
Rehabilitation session co-payments $25 x 6=$125
TOTAL: $765

Of course, this is just an estimate based on my most recent visit to a US ER. And, the number of doctor and rehab visits might be fewer or there might be more. This calculation does not include the $200 per month out of Sarah’s check to pay for this healthcare coverage. Anyway, the out-of-pocket cost to us in Canada was $0. I can wait an extra two hours for $765.

I’m not naïve enough to think that we weren’t paying anything for this healthcare. Clearly, every time we put gas in our cars, get a haircut, go shopping, or go to work to earn money, we’re paying for the healthcare in higher taxes. The difference is that we will never be in a position where we can’t afford necessary healthcare coverage while we’re in Canada. That could happen quite easily in the US.

The evils of co-payments and coinsurance are quite apparent. However, they are also probably directly related to the difference in wait times between US and Canadian healthcare facilities. For example, people who have to pay $50 or more just to walk in the door of an ER won’t go there when they feel dizzy or think they might be having an allergic reaction. In the US, people who feel dizzy will take a nap and see if they still feel dizzy when they wake up. If they do still feel dizzy at that point, they’ll probably go back to bed. Most people won’t cough up the $50 or more to visit the ER until they are certain something is seriously wrong. Also, people who feel well enough to sit quietly and do crossword puzzles or who feel well enough to stop for takeout food on the way to the hospital won’t be in the ER in the US as often, either.

Then again, there are some people who have insurance with no deductibles who abuse the US emergency healthcare system. There are also people in the US who, when seriously ill and in need of emergency healthcare, don’t seek care because they cannot afford or do not want to pay the required co-payments. By the time they do seek care, their condition has worsened.

I’m not sure what the answer is, because I understand the fundamental premise of the Canadian healthcare system is to provide equal healthcare to all. Yet, co-payments can often be a deterrent to keep people who don’t require emergency care from visiting the ER. All I know is that when I was in the US, if I broke a bone or had a kidney stone, I was in too much pain to worry about paying the co-insurance co-payment, and so went to the hospital. I can’t imagine what it would be like to be in the same situation with no insurance at all. Because I’m in Canada, I probably won’t ever be in that situation.

1 comment:

Doris said...

Hi Mary, I like reading about healthcare system in Canada and US. For about 5 or 6 times in my life I had to go to ER and never waited more than 40 minutes because of my health insurance. But who depends on public hospitals here, the situation is chaotical.