Post by #Healthcare4All team member Megan
Editor’s note: If the video below isn’t working, you can also view it on YouTube by clicking here.
(Transcript available via the link as subtitles)
We all use the Canadian healthcare system, but do we really know how it works? I recently ran across this video from Aaron Caroll at Healthcare Triage and it helped me start to think about how healthcare is delivered in Canada. This short video isn’t perfect (health care systems are complex), but it does a good job of outlining the system in a short period of time. There are a few points worth highlighting and clarifying, however.
Who pays what? [0:42-1:30]
Let’s take another look at what Aaron is saying here about payment in the Canadian system. When you get what the government deems to be a necessary medical service – visit a clinic for the flu or break a leg or need an x-ray – you (or your parents) do not pay a specific price. In the Canadian system, we have a mix of public spending and private delivery (See the table below for details). For the issues I’ve just listed, your service will be publicly funded, although it could be delivered by a public, non-profit or for-profit private provider (See the tables below).
In order to fund public services, all British Columbians pay into one big pool of money through taxes and Medical Services Plan (MSP) premiums. This pool of money isadded to by the federal government as well, through transfers. Using this pool of money, the government pays for the items in the public “Financing” section in the table below. We don’t pay for these services when we access them; instead, the hospitals, institutions, clinics and doctors will charge the government. (See the top, yellow “Delivery” section of the table below.)
They call this a single-payer system, because the government is billed for for everything (everything that is covered, anyways, though that is a different issue!), instead of each person paying individually.
In Canada, we do have some private financing already, which you’ll see in table as well. You’ll also note a trend: private funding is generally expected for extras, enhancements, and extended care. Of course, some of these services do feel pretty necessary, like vision care services. This coverage may change depending on what a provincial government considers to be primary health care for specific groups.
For example, the Medical Services Plan (the single-payer insurance coverage for British Columbians) covers 1 annual eye health examination for those 0-18 years older or over 65 years old. For these age groups, an annual eye health exam is deemed a necessary medical expense, because of the increased risk or need that these groups face.
To see the table in action, think about the following examples: if you break your arm and go to a hospital, you’ll likely be using a private non-profit provider, i.e. a hospital run by an organization, not the government. If you’re getting an annual check up at your local doctor’s office, you’re using a private for-profit provider. In both cases, the services are publicly funded. On the other hand, if you wanted to get your wisdom teeth removed, you would be seeing a privately funded, for-profit provider for dental care.
How much are doctors paid? [1:30-1:44]
Doctors do not get a bad deal here, as Aaron explains that an average Canadian doctor receives $225 000 a year. It will vary depending on the type of doctor, but that is quite a pay cheque! There is a myth that many Canadian doctors are running away from Canada to get paid better in the United States, but Aaron tells us that this isn’t really true [3:00-4:00].
What’s with the wait times for surgeries and scans? [1:48-3:00]
Wait times for services get a lot of attention and they may not be perfect, but they are typically for things that are not immediately life threatening. From where Aaron stands, wait times are not a problem with having a public system; they are actually a problem of funding [6:00-7:15]. “Canadians spend remarkably little on healthcare” in comparison to other similar countries, and much less than the United States [2:30-2:38]. If Canadians wanted to pay more taxes, or if we pressured politicians to put more of the current taxes towards healthcare, we could lower wait times.
Other reports have suggested that the way that wait lists are managed may be to blame for the long wait times, not a lack of funding, and these issues could be changed within the public health care model. Reports like Why Wait? even identify pilot projects that present new options for improving health care. Changes like standardizing practices, improving how operations are scheduled, increasing efficiency, developing regional wait lists and other organizational changes have had significant impacts on the wait times in these projects. It may not be a matter of money but how that is spent and what is prioritized.
So, the solution to long wait times is not to get a new system. It’s to fix the present one. That way, they would be fixed for everyone, not just for people with enough money to skip the line. Some people (but far fewer than you’d think) skip the line by going to the United States, but wait times for Americans aren’t even always better than in Canada [2:15-2:25, 4:00-5:55].
If you want to check out the wait times by province, you can find that information right here.
It’s easy to get confused about Canadian healthcare when you tend to hear conflicting stories about how it all works, but we can always check in on what the facts, studies and surveys say about our healthcare system to get straightened out. Overall, Canadians have a system that we can be proud of. If anything, we need more of it, not less public healthcare!