By Robert Field
On a trip to Halifax, Nova Scotia Province, Canada, a NewsLanc reporter conducted an informal focus group consisting of a registered nurse, an engineer, a stock broker, a business consultant and a physician in general practice.
They were asked their opinion of the Canadian mostly government operated health system and in all cases they had favorable and virtually identical opinions.
Everyone agreed that health emergencies were rapidly addressed, although they recognized that elective surgeries such as hip replacements and hernia repairs require half a year and sometimes longer on a waiting list.
The following day NewsLanc interviewed the physician at length. What follows are NewsLanc’s questions and the physician’s replies:
NL: If someone breaks an arm, has a heart attack, acute appendicitis, acute amorism, how long does it take for them to be treated at a hospital?
DR: “As soon as the person arrives, they will make sure that they are triaged properly. Under normal conditions, they would be sent to an orthopedic resident. If busy, staff will make sure you are comfortable, and then send you for an x-ray, and then they use an anesthetic to set the bone and then apply a cast. It would normally take a couple of hours before treatment. Charges would come to $0.”
NL: How long of a wait is there to see your family doctor?
DR: “I would see 90% to 95% my patients that day or next. If you have to wait two weeks, you’ll either be cured or dead.” He allowed that some doctors do take longer.
NL: What do patients pay under the Canadian system?
DR: “Under 65 for office call, [the] government pays [the] doctor $29.38 and [the] patient pays nothing. A senior who comes to the same office, [the] government pays $37.29 and [the] patient pays nothing. Reasoning is that seniors have more problems. Payment is gross revenue for the practice.
“For an H1N1 flu shot, [the] government pays a flat rate of $13.66. In addition, there is a government payment of $3.34 to pay for the syringe and other materials. The flu medication is supplied by [the] government without charge to doctor or patient. Certain less common inoculations such as yellow or hepatitis are not supplied by the government and are paid for by the patient.”
“For a house call after 6 PM or on weekends, [the] government pays $63.96 for first ill person in household and $29.38 for each additional sick person in the house. House calls during regular office hours are $48.24. Patient pays nothing.”
The doctor mentioned that his medical liability insurance only costs him about $2,000 per year, presumably because damage awards are fewer and much smaller in Canada.
NL: What if you need an operation for an emergency?
DR: “You may have to wait several hours to arrange for an appropriate surgeon. Patients can have complicated procedures such as a bypass surgery, a kidney transplant, or even a heart transplant without cost to the patient.”
NL: What about waiting time in a hospital emergency room for a sprained ankle or sore throat?
DR: “That can require many hours, because more serious cases receive priority. There are Walk In Clinics (‘Urgent Care Clinics’) all over which are part of the health care system where waiting time would not be long. They will treat [the] patient and FAX what they did to his or her family doctor. The government pays. Hospitals are encouraging patients to use Walk In Clinics.”
NL: What about the wait period for elective surgery such as hip replacement, knee replacement, gall bladder when there is no critical need.
DR: “Elective surgery can take one to two years.”
(He digressed to tell a horror story of someone with acute appendicitis waiting two days in a corridor. But he said this was a rare administrative snafu.)
“Surgeons are only allocated so much time in hospitals to perform work. Delays result from lack of facilities rather than shortage of specialists.”
NL: What do doctors earn in Canada?
DR: “A typical general practitioner after paying office expenses will net perhaps $100,000 to $120,000 a year.” (The physician interviewed earns more but works longer hours.) “Some specialists work for fees and others are salaried. Their earnings range from $300,000 net to $500,000 net. They are paid by the government.”
He added: “Some general practitioners can make a living just working at a hospital by assisting in surgery. They typically receive 25% of the surgeon’s fee.”
NL: What entity runs the government health service and what is its source of funding?
DR: “Medical Services Incorporated is government run and revenue comes from a 13% sales tax which amount varies slightly in some provinces.”
NL: Are there private clinics apart from government funded clinics?
DR: “Private clinics are almost non-existent in Nova Scotia, although there are more in other provinces. Patients pay them for services. There is only one private MRI clinic in the province of Nova Scotia. It charges $700 on up. They don’t do CAT Scans at private clinics. Also private clinics do plastic surgery at patient expense.”
NL: What do patients pay for pharmaceuticals?
DR: “A non-senior pays for medicine at a pharmacy with a prescription. About half of the people have some over private insurance coverage through job or family.
“A senior at 65 can buy into government plan for $400 annually. If they join later, they are charged up to $700 annually. In return, the government pays about 70% of the cost. If patient can’t afford the 30% charge, there are provisions for additional government assistance up to 100%.
“Generic drugs are given priority. However, when medication is not sufficiently effective, exceptions can be obtained through the pharmacists consulting with the government medical services.” (Like many US physicians, he is not an admirer of generic drugs.)
NL: What is the cost of medical school?
DR: “At least 80% is paid by the government, normally without restrictions. I have recommended there be a commitment for the doctor to remain in the province paying for the medical education for a period of time, but this isn’t done.”
NL: How are nurses, pharmacists and dentists paid?
DR: “Nurses are also paid by [the] government. Pharmacists are paid by employers. The dental system is private. Dentists make more money than doctors, a ton more. There is charity performed at dental schools. Veterinarians make a fortunate, better than doctors and dentists.”
