Below, a letter from a Canadian disputing some of the propaganda that we hear about health care in Canada. (Thanks to HealthBeat reader Lisa Lindell for putting me in touch with Vera Goodman) This is the first in what I hope will be a regular series featuring letters from patients, doctors, nurses and others describing how health care works in their countries.

Since I believe that the best reporting combines stories and statistics, I’ll add some stats, as I have here, in brackets.

The next letter will be from a doctor in Norway who has practiced medicine—and been a patient—both here in the U.S. and in his home country.

Dear Maggie

I can’t believe some of what I hear from the US supposedly telling the “truth” about our Canadian health care system. 

Here is the reality: Every citizen of Canada has health care for doctor visits, emergency, hospital stay and surgeries.  In some provinces there is a small annual premium.  I believe it was about $600.00 per family here in Alberta until last year when my province eliminated the premium.     I think this was unfortunate because now that we have a downturn in the economy, they say they don’t have enough money and they are cutting back on nurses, hospital beds and programs.  Why didn’t they keep the fee and maintain the programs?  Saskatchewan has no user fee and I don’t know about the rest of the provinces.

We are free to choose our own doctor and to go to more than one doctor for diagnosis if we want to.  With our growing population, some are finding it hard to find a family doctor. Our government capped the enrolment in medical school a few years ago.  Also, we lose doctors and nurses to the United States where they don’t have to work as hard for a lot more money!  Here, doctors fees are regulated but, on the other hand, they don’t have to worry about collecting money, finding patients or non-payment. 

[While its true that higher incomes and newer equipment have lured some Canadian doctors to the US , emigration hit a peak in the mid-1990s, and has now slowed to a trickle.   The Canadian Institute for Health Information charts migration patterns for practicing physicians. According to the Institute’s data, the gross number of doctors leaving the country hit two peaks in the last 35 years: one in the late 1970s, when Canada lost between 500 to 600 doctors a year, and another in the mid-1990s, when it lost around 600 to 700 a year.  But when assessing the brain drain, it’s important to consider not only the number of doctors who are leaving, but also the number returning to Canada. This number has been holding fairly steady since 1980, with around 250 to 350 returning per year. Thus, the net loss of physicians is fairly small.]

[And in recent years, not only has the brain drain trend slowed, it has actually reversed. In 2004, Canada gained 85 doctors. In 2005, it gained 61 physicians and in 31 in 2006.]

[How many leave Canada for the U.S.? Since 1992, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the U.S.  spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada. mm]
      
Vera continues: Though,  according to the Canadians who have had to be treated in the US, your doctors don’t have to worry either as patients have to either present a credit card before seeing a doctor, or pay  cash up front  wouldn’t put my foot across the border without my holiday health care extension.

[This is true. At least in Manhattan most doctors do ask for your health insurance card,  a credit card—or cash—before the appointment begins. Hospital outpatient clinics and even some ERs ask for an insurance card or a credit card. In Money-Driven Medicine I tell the story of a man with a broken jaw who was denied care at three hospital ERs because he had neither. He did have proof that he was a citizen and a resident of the state in question, but that wasn’t enough. Legally, an ER can turn a patient away if he is capable of walking out the door. mm]

Vera  continues: I can go to my doctor with things that are not major and thus prevent a more serious condition from developing.  Because we all share the cost, even the street people can get care in our hospitals.

I believe that makes for a healthier population and prevents the spread of diseases.  Anyone who has a serious condition that needs urgent attention goes to the head of the line in emergency and is treated quickly, no matter what their financial or social standing may be.  Our doctors and nurses are second to none and give excellent care.

It is true that we sometimes have to wait for surgeries such as hip or knee replacements, but at least we get them.  I heard that a hip replacement is $60,000.00 in the US so if I had a problem, I  would end up in a wheel chair because I could never pay that much from my pension. 

[Canada has set benchmarks for how long a patient should be expected to wait for certain surgeries: for elective hip or knee replacement, the wait is six months.  These are not emergency surgeries, they are elective. Some patients would prefer to have the surgery as soon as they have decided to do it. But six months gives them time to read up on what will be involved in recovery, to do some physical therapy (always a good idea before joint replacement ) and generally to make sure that they are in the best possible health before going into the hospital.] .

[In emergencies, care is timely. Among patients who fracture a hip, 85% receive surgery within three days of being admitted to the hospital. Just 8% spent four or more days in the hospital preceding surgery; in many cases these were patients suffering from co-morbidities who needed to be stabilized before going into surgery. ]

[Vera says she would never be able to afford hip surgery if she had to take the money out of her pension. But of course the patients in the US who have hip replacements usually have good insurance—they don’t pay for it out of pocket.  And $60,000 is a high figure. Still, if you’re under 65 and don’t have very good insurance , you may find that your insurer doesn’t pay for inpatient rehab after the surgery. Some insurers don’t even  pay for outpatient rehab or rehab in your home. And if you’re under 65, don’t have insurance and are not poor enough to qualify for Medicaid, you can probably forget about hip replacement.  In addition, Americans with very high deductibles might well have to put off hip surgery until they’re on Medicare. .Once they’re over 65, traditional Medicare will cover 80% of the cost of hip replacement; if you don’t have a supplemental private insurance policy (like MediGap) you will have to pay the remaining 20%.]

[Bottom line: in Canada Vera might have to wait six months—or even eight months–for hip surgery she knows that, if she needs it, she will get it, even if she is unemployed– and it won’t cost her a dime. mm] 

Vera adds: Because we don’t have enough specialist doctors, the wait to see them is excessively long but it’s not because they aren’t covered through our medical system.

[ It’s impossible to generalize about wait times in Canada. They vary widely. Generally, they are much shorter if you need to see an oncologist than if you need an orthopedist. Wait times also vary by province; they are shorter in cities; longer in rural areas. For a fairly balanced picture, see this. -.mm]

Vera continues: Our health care system was started in the 1940’s in Saskatchewan by Tommy Douglas.  My father was a part of the party that introduced these services.&
#0160; The doctors went on strike to protest but they soon saw its advantages and came on line.  Although Tommy’s been dead for some time, he was recently voted as the most important Canadian of the century.  I believe we have health care because it was started at a time when it was easier to implement and built it up gradually.

What I see as a problem for you will be the infrastructure – having enough hospitals and doctors to treat the masses that have not had adequate health care to date.  I’m not sure you can implement it very quickly but maybe I don’t understand the situation. [I think Vera has a point.mm]

There are many benefits to living in Canada but Health Care is the most important for me and my family. It is so wonderful to know that if I get sick I will receive excellent treatment. I can see my doctor within three or four days and sooner if it is a more threatening problem.  It takes longer to see specialists but at least I get to see them which I would not be able to do in many countries in the world.

Best regards,

Vera Goodman