Thursday, August 20, 2009

Canadian Health Care System - part I

I was asked to write about our system in Canada, as there is much misinformation in American news about our weird ways.

Basically, health care is a Federal government responsibility, and our federal taxes are collected and dispersed to the provincial or territorial governments.

Each province and territory is responsible for looking after its health care system, they do differ province to province, and territory to territory slightly. This allows for differences withing these areas. The Canadian Government's mandate: health care is free and accessible for all. The philosophy is that we are all entitled to publicly provided health care. There are some who go to private clinics, and these people who provide extra services do so apart from the rest of the system.

This does not include drugs or dental plans, although some of us buy into private plans. As a retired teacher, I pay $200/month for my Retired Teachers of Ontario Plan. We also have Blue Cross, and various plans for particular employees, which is negotiated with our employers, e.g., federal or provincial civil servants, municipal employees, or private businesses who have collective agreements that specify this benefit. That is to say, I can privately pay or purchase insurance to pay for a private room in a hospital or long-term care (LTC - formerly a nursing home) home, rather than a 4-bed ward. I can supplement the benefits of state health care, but we are all provided with a standard of care the determines that we are equal. More about LTC and seniors and complex geriatric and palliative care in my next post!

That said, in all practicality when I go to see my family physician I take my health card with me. They swipe it at reception, the physician is reimbursed for the appointment by the government, whom they bill for their services. If s/he writes a prescription, I take it to my pharmacist, who fills it and I pay for it. Since I have a drug plan, I submit receipts and I am reimbursed. If I need a blood test for, say, cholesterol, I take a chit, signed my my physician, and the test is done in a lab and billed to the government, after swiping my little card! If I am referred to a specialist, I similarly take my health card, which is swiped, and this visit is paid for by billing the government.

My physician is part of a Family Health Team (FHT); the direction in which my province is heading. Some physicians, in fact many, collaborate if not in a FHT, then in a clinic with the benefit of both appointments and 'Walk-in' times. Some, of course, continue to work alone, although in terms of patient care, senior complex care, and the cost of providing services, many have opted in to a clinic or FHT.

The FHT is a relatively recent development. Under one roof you will find your physician, a nurse practitioner, nursing staff, dietician, and so on.
Read more here: Understanding Family Health Teams. A Family Health Team is an approach to primary health care that brings together different health care providers to co-ordinate the highest possible quality services.

Basically, the goal of the FHT: disease management and prevention, disease cure, rehabilitation, palliative care and health promotion.

If have problems with nutrition, or weight, I can book a visit with a dietician through my FHT, attend a lecture on cholesterol and carbohydrates, and learn how to prevent obesity before it is too late. This saves a great deal in terms of physician and nursing time. Many women are underdiagnosed with high blood pressure, cardiovascular issues are underdiagnosed in women. A little education in this area goes a long way. My family doctor found I had high cholesterol and I tried to manage it with diet. This did not work. I take pills, which I claim from my private plan, and I have a blood test to monitor my progress every few months.

In my situation, retiring posed many new issues. I was eating the same amounts, but not working I used fewer calories. I have increased my exercise, been given booklets on nutrition, and exercise, and I am hoping to improve. This will prevent me from developing chronic care issues. And save the system money. That is how our system works. If you have any specific questions, pleas pose them! I'll be happy to try and answer them. I did much research for my book (Living and Dying With Dignity - see the sidebar) and learned a great deal. I also worked as a Peer Health Educator with a non-profit Transfer Payment Agency, to provide education on cardiovascular issues on a contract basis.

Check out the topics on the sidebar for Cardiovascular Health supports, e.g.,

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