Canadian health care is one of the few areas that the government is rightly proud of. Health care in Canada is publicly funded and is best described as a system of insurance and health plans for ten provinces and three territories. This system is known as Medicare and provides free or virtually free health care to all Canadian citizens.
This structure was developed because health care in Canada is administered by local, provincial governments, not the federal government. Each province or territory’s health care system is bound by the same principles that are set at the national level.
The management and provision of health care services in Canada is the responsibility of each individual province or territory. Provinces or territories plan, fund, and evaluate the provision of hospital care, therapists and other specialists, and some medicines.
The federal government’s role in the health care system is limited to establishing and enforcing the general principle of Medicare, partial funding of provincial or territorial health programs, and other functions specified in the Canadian constitution. One of these functions is the direct medical care of special groups of Canadian citizens, which include veterans, aboriginal Canadians living on reserves, military personnel and members of the Royal Canadian Mounted Police. Other functions are prevention and protection of public health and promotion of healthy lifestyles.
Canada’s health care system relies primarily on primary care physicians, who make up about 51% of all practicing physicians in Canada. They are the conduit between the patient and the formal health care system, and control access to most specialist physicians, hospital care, diagnostic checks and prescription medications. Such a family doctor can be changed an unlimited number of times on the advice of acquaintances and changes in mood.
In Canada, however, there is no “public health” system where doctors work directly for a government agency. Most doctors have their own private practice and enjoy a high degree of autonomy. Some doctors work in hospitals or local health centers. Private physicians are paid by the government based on the care provided, with such physicians paid directly from the provincial or territorial budget. Therapists who do not have a private practice receive either a set salary or a fee based on the amount of care provided.
When Canadians need medical care, they go to the therapist or clinic of their choice and show their health insurance card, which is issued to all legal citizens and residents. Canadians do not pay directly for medical services provided, and they do not need to fill out various forms for services covered by insurance. There are no monetary limits or co-payments for such services.
Dentists are independent of the health care system, except when an emergency dental surgeon is needed. Pharmacies are also independent of the government.
More than 95% of all Canadian hospitals are non-profit private organizations run by a local board of directors, volunteer organizations, or municipalities.
In addition to the national health insurance system, the provinces and territories also provide health care services for that part of the population that needs supplementary health care services – the elderly, children and the unemployed. These supplemental health care packages often include free medicines, dental care, eye care, various devices for the disabled (prostheses, wheelchairs, etc.), and more.
Although the provinces and territories provide additional services to some segments of the population, these services are in the private sector, which means that residents pay for them directly out of their own pockets. The sensible thing to do in this case is to buy insurance that covers most of the costs of dental services, opticians, etc. Such insurances are often included in the compensation package offered along with your salary.
When moving from one province to another, Canadian residents can still count on free medical care.
In the first year, new immigrants pay the maximum rate for health insurance. In the second year, a provision comes into effect whereby, if income does not exceed a certain amount, immigrants are exempt from the premiums or reduce them to a symbolic amount. The annual income of the resident is taken into account in calculating these premiums, not the amount in his bank account, so that the formally unemployed can claim free medical care.
Health care in Canada is financed mainly by taxes, both local and state income taxes and corporate income taxes. Some provinces use sales taxes and lottery income to fund health care. These additional revenues, however, do not play a large role in financing health care in Canada.
To strengthen the health care system, in 1999 the government announced that the provinces and territories would receive an additional $11.5 billion from 1999 to 2004 for additional system needs. Reform is coming, but its essence is only to improve the existing order of things, not to create a fundamentally new way of insuring and providing health care for Canadians.
One of the most important indicators of the success of the current health care system is the health of Canadians. Canadian life expectancy is 78.6 years (81.4 years for women and 75.8 years for men), one of the highest among developed countries. The infant mortality rate in 1996 was 5.6 per 1,000 live births, one of the lowest rates in the world.
In the United States, unlike in Canada, health care is fee-for-service. If you go to a hospital in the United States, you can’t avoid problems. The average fee per day in the hospital is about $800, and this amount does not include the medical services themselves: surgery, hospital care, medications, etc.
People who have insurance pay up to 80% of the cost of a hospital stay, the remaining 20% you have to pay yourself. However, Americans manage to save money on hospital care by cutting costs to a minimum.
For example, American patients bring a pillow, sheets, clothes, and slippers with them to the hospital, which would cost them an extra $300 a day. They also recommend not eating hospital food and asking relatives to bring them food. Going to the hospital for a checkup should be on a Thursday so as not to pay for a weekend when no tests are done, but there is a charge for the hospital stay. It is highly recommended that you study the bill carefully, because it often includes services that you do not receive. If you need to go to a hospital, compare the rates of several hospitals – the difference can be very substantial.
Ideally, it is better not to get sick at all. This is why there is such great, even painful attention to their own health. So many people jog, go to sports clubs, etc.
Tips for immigrants
Everyone in Canada has free health care, but each province has its own health insurance system.
The way health insurance works is that all services from Canadian doctors are not free, but the government pays for them. That is why there is a health insurance system. In Ontario, it is called Ontario Health Coverage. To enrol in Ontario Health Coverage, you must visit one of the Ministry of Health offices within a few days of your arrival, fill out a form called “Registration for Ontario Health Coverage” and have your photograph taken.
You will be given a Health Card with your health insurance number on it. The Health Card is a plastic card with your photo, signature, health number and home address on it. The Health Card, like your driver’s license, is your identification document. It is given to every family member, even children.
It is important to know that during the first three months after you move to Canada, you are not eligible for government medical insurance. That’s why you would have to take care of your health yourself by purchasing insurance from a commercial insurance company. The average price of an insurance policy that covers all medical services for three months will cost you about $150 per person. It is possible to get cheaper insurance, but in this case you will not pay for all medical services. Although for newcomers insurance costs seem a waste of money, it is worth buying insurance policies at least for children – they are more at risk of disease during the acclimatization.
During these three months it is advisable to take extra precautions and, if possible, not to get sick or injured. There have been cases where people who came to Canada, in the first days have received serious injuries. Without insurance, a stay in a Canadian hospital will cost about $2,000.
Always bring your Health Card with you when you go to the hospital or your doctor’s office, as you will need to show it. There is a special Health 65 Card for Toronto residents over the age of 65. With these cards, seniors get a lot of benefits when they buy medicine.
The Ontario Health Card does not pay for dentists, cosmetic surgeons or alternative medicine (homeopaths, etc.).
If you have a very sore tooth, you can go to the emergency room of a nearby hospital. They will see you and refer you to the dentist on duty. However, do not count on the attention of a specialist and qualified help – you will simply pull the sick tooth, thus providing emergency care. If you want to save your teeth, see a dentist and do it as early as possible. The cost of treating one tooth is about $50 to $100. Complicated or serious cases can cost more – up to $500 to $600. Technical dentures will require much more money.
If an employee is hired permanently (not on a contract), he is offered a compensation package (benefits) in addition to his basic salary. Most often this is health insurance for dental services for the whole family, usually not exceeding $2,000 to $3,000 a year.
There is a special program for school children, whose parents cannot afford to pay for dentist’s services, where they are treated by dentists, working under the contract with Education Canada. This, of course, is a considerable help to the budget of people who have not yet settled down in the country, but the quality of treatment by such doctors is markedly inferior to the quality of treatment by paid dentists.
In large cities, it is possible to get dental treatment at a discounted rate by using the services of “illegals.” “Illegals” are immigrant dentists who cannot practice until they pass their exams and get their diplomas approved. This procedure usually takes two to three years, and sometimes more. During this time, immigrant dentists begin to practice illegally. The quality of their services is not inferior (and sometimes surpasses) the quality of the certified Canadian doctors, and prices are much lower (treatment of a tooth will cost about $30, and prosthetics – $100). If you have not been offered a compensation package at work, you have your own business, or any other situation that forces you to pay for dentist services out of your own pocket, it is better to use the services of illegal doctors. Obviously, “illegals” don’t advertise in newspapers, so you should look for them through people you know. However, as soon as an “illegal” dentist confirms his diploma, he opens his practice and raises his prices, so you should look for a new doctor.
Choosing your doctor
Canada has a family doctor system. Under this system, you can choose a doctor to monitor the health of all members of your family, to visit you if someone in the family gets sick, etc. However, it is very difficult to find a family doctor in a large city – the demand is high, so doctors are not interested in serving a large number of families.
If you have an ailment, you need to go to one of the medical offices (analog of polyclinics in Russia). There you will be able to make an appointment with any of the therapists in the office. You can also make an appointment by phone. However, do not expect to get to the doctor’s office at the appointed time – there are also queues in Canadian medical institutions.
There are many Russian-speaking doctors in Toronto, especially in the North York area. It is wise to go to them if you have problems with English, because if you have something serious and need a consultation with a specialist, you should visit a GP and describe your symptoms in detail, because it is the GP who will decide which specialist to refer you to.
In such a development, you need to go to the hospital – to the emergency department. Go there for any case – if you received an injury, you have a fever, internal pains, etc. In the emergency department you will be seen by the doctor on duty, and then by the specialist on duty, who will give you the necessary care. If necessary, you will be hospitalized.
If you are unable to get to a hospital on your own, and you need immediate medical attention (difficulty breathing, heart attacks and other possible causes of death), call 911 for an ambulance. An ambulance will come and take you to the emergency room at the hospital, where doctors will take care of you.
Most drugs with a “name” are the same as those without a “name,” which are called “generic” or “generic” drugs. The difference in price can be anywhere from 20% to 800%. For example, the sedative medicine Valium costs US$21.79 in the U.S., a similar medicine, Diazepam, costs $7.99 and the medicine for bacterial infections Keflex costs $46.79, its “unnamed” counterpart, Cephalexin, costs $21.79, the relaxation drug Inderal is $18.49, its counterpart Propranolol $4.99, the muscle pain drug Flexiril costs $25.79 and its counterpart, Cyclobenzaprine, costs US$20.49.
Canadian pharmacies sell drugs made in Canada, almost every one of which has a cheaper equivalent. Take my advice: When your doctor prescribes you medicine, ask if it is possible to use generic. If the bad doctor does prescribe an expensive medicine with a “name”, ask the pharmacist the same question. Pharmacies are supposed to sell only the drugs listed on the prescription, but on rare occasions they can be incredibly understanding. Also, don’t hesitate to ask your doctor if he or she has the drug prescribed for you himself or herself, as pharmaceutical companies often supply doctors with free samples of medications as an advertisement for their product.
If you are prescribed a long course of treatment, buy drugs in large packages – it is cheaper by 25-30%. For example, a package of 100 aspirin tablets costs US$8.99 and a package of the same aspirin 50 tablets costs US$5.99. In the first case you pay 9 cents per pill, and in the second – 12 cents. Such savings are unusual for Russians. In contrast, residents of the United States and Canada are advised to count the number of pills and compare it to the number indicated on the package. Also note that there are discounts for seniors when purchasing medications at pharmacies. Remind both your doctor and pharmacist about this.
Like food, the same medications cost differently in different stores. Drug Mart specialty pharmacies have the highest prices, stores like Saveway or London Drugs have slightly lower prices, and Super Stores have even lower prices. The above-mentioned drugs have the following price differences (in U.S. dollars) in these stores: Cyclobenzaprine costs US$14.83 in the Superstore, and 15.60 in Saveway; in the specialty store, i.e. the drugstore, it costs $17.80. i.e., in the pharmacy, 17.45: Diazepam, respectively, 5.66, 5.10; 10.90; Flexiril, 20.53; 20.40; 23.10: Keflex, 40.98; 38.45; 45.17; Valium, 16.98; 16.05; 29.84. Although these data are taken from U.S. examples, the situation is the same in Canada.