Canadian Nurses: How do you like your healthcare system?

Fiona59 · Dec 29, 2007

The only issues I have with our healthcare system are personal ones.

I'm tired of seeing a fortune spent keeping people alive against all odds because the family either believe "god can fix it" or "she's only 98 and not ready to die". The body wears out and can only be fixed a certain number of times.

The NICU is another area (sorry Janfrn). Some of those babies are so tiny, fragile, and face so many obstacles in their future. Is saving a life at any cost realistic.

I'm tired of patients saying "it's better in the States". Then asking about their experiences and finding out that a friend of a friend told them that there is better healthcare down south. Well, explain to them how expensive health insurance is, how you still pay a user fee on top of your insurance, and oh, certain insurance companies limit your choice of Doctors, well, suddenly our system is just fine. They leave the hospital without a bill in their hand unless they opted for a private room.

If you have an accident and need it done now there is NO wait, it is fixed. Many of the knee replacements, well, provinces have initiatives to push these surgeries through. BUT there are limits to how many hours nurses, PTs, etc can work. We have a nursing shortage up here and those of us left working need our vacations, time off to have babies, etc.

People have unrealistic expectations of any system and we are seeing more and more issues arise due to cultural issues. My area has a lot of Somalian refugees, when they deliver the women expect to "lie in " in the hospital for about "ten days" before they go home. Back home isn't here and some have complained long and hard about how we are not respecting their culture. No healthcare system can or should provide ten days for a newly delivered woman and infant who have no complications.

Lately bariatric surgery has become somewhat of a craze in my hospital. When those go wrong they really go wrong and wind up costing the Province a lot to correct.

People want a quick fix. You didn't wake up weighing 198 kilos. Yes you have sore joints, but diet and exercise before undergoing the knife.

Off topic I know, but our system isn't bad nor is it great. BUT it is available for all.

Pediatric Critical Care Columnist · Dec 29, 2007

The NICU is another area (sorry Janfrn). Some of those babies are so tiny, fragile, and face so many obstacles in their future. Is saving a life at any cost realistic.

Hey, don't apologize to me... I haven't worked neonatal in more than a decade, and I totally agree with your POV on this. The system spends so much money, time, effort and emotion on these babies who should have been allowed death with dignity, with no guarantee of even a poor outcome. They keep pushing back the limits for resuscitation to the point where they're "saving" fetuses for a life, however brief, of pain, constant handling and frequent emergencies totally devoid of human(e) touch. 23 weeks is not enough time to become self-sufficient! I see things too in the PICU that make me want to shake people and ask them just what they think we're doing to the child and to the family... notice I said "to" and not "for"... But as you say, this is a little off topic... a debate for another thread maybe.

To return to the topic at hand:

For all its flaws, our system is truly inclusive. It covers all comers, no matter where they are from or what is wrong with them. Perhaps our care isn't quite on the cutting edge, as it is in some of the more wealthy hospitals in the US, but our outcomes, morbidity and mortality stats, longevity and quality of life suggest that we're not far behind.

Because our relatively small popluation base is spread widely over the second largest country by land mass in the world, our major hospitals are usually regionally supported and utilized. It doesn't make fiscal or practical sense to offer the broadest possible range of services at every hospital with more than 50 beds across the country. So specialized things like MRI, CT, cardiovascular and neurosurgery, organ transplants, cancer care, high-risk obstetrics and intensive care tend to be centralized. Skills are better maintained if they're used regularly. And our single-payer system recognises the need for centralized services by paying for them in the location they're obtained, and paying for transportation to and from the center doing the providing. An example of this is the Western Canadian Children's Heart Network. The vast majority of pediatric heart surgery for children living between the head of Lake Superior to the Pacific Ocean is performed at the Stollery Children's Hospital in Edmonton, Alberta. There are two world-renowned pediatric cardiovascular surgeons and a handful of equally recognised cardiologists who work from there. Each province provides transportation for the child and one parent escort to the Stollery, and the parent is provided with accommodations at Ronald McDonald House, the outpatient residence at University Hospital, Campus Tower, or a variety of other options, at no out-of-pocket expense to the family. The home province pays the usual and customary charges for the surgery and hospitalisation. The child and family receive world-class care for as long as necessary; their only financial responsibilities are signing an interprovincial health care coverage form, any loss of income they may experience due to being away from their workplace and for their own meals and entertainment. I have personal experience with this; in 1989, while we were living in Manitoba, my then 5 year old son and I travelled to London, Ontario for his liver transplant. We were there 5 months. I believe that had we lived in the US, we'd have been bankrupted before he finally came home. That he is alive, healthy and living well with his transplanted liver 19 years later is validation enough for me.

There is a lot of discussion about waiting lists. I've had experience with that too. I waited a year for my hysterectomy, but it was completely elective. I was tired of the symptoms I was having, but it wasn't threatening my life in any serious way. (I also turned down two earlier dates because they would have been difficult to fit into my schedule!) My mother, on the other hand, waited only three weeks for a bladder and uterine suspension from the moment the need was determined. As fiona59 says, if it's urgent, it's done urgently in the majority of cases.

One area where there could be great improvement is in the provision of mental health care. But I don't think that's related specifically to the single payer system as much as it is to the philosophical remodelling of provision... moving the mentally ill from protected institutional settings into the community without thinking through all the implications.

Other myths circulate about Canada's health care, such as the government decides which doctor one sees or which hospital one attends. Totally not true... Canada doesn't have HMOs...

There are a couple of other similar threads on this forum you might want to check out. Some interesting discussion.

OgopogoLPN, LPN, RN · Dec 30, 2007

Here's a copy of a responce I gave to a similar thread a while ago:

1. No! The health care is not poor! If people are urgent or emergent, they do get seen very quickly. Maybe not as quickly as they'd like, but they do get priority. The general surgeons in my area have specific time blocked off every week for women with breast cancer diagnoses. A woman will be seen within a week or so with this diagnosis and a mastectomy/lumpectomy or whatever schuduled within 2 weeks or so (or sooner if it's a later stage cancer).

I developed complications with my 2nd pregnancy and the day of my ultrasound my doctor recieved the results she called me from her home and had me see the top OB/gyn in the city THE VERY NEXT DAY. This doctor normally has a wait list months long for more 'elective' things.

I used to work for a plastic surgeon and if we received an urgent/emergent referral, that person would be seen immediately/within a day or two.

There are definate flaws in the system though, no doubt about it. Anything considered "elective" can have a VERY LONG wait to be seen in consultation and then surgery. The OR's at my hospital run at full capasity during regular OR time and often into the night to catch up on surgeries. My daughter jammed her two front teeth into the coffe table and had to be put under to have them extracted (she was 2). We were told to bring her to the hospital at 8am, npo, for surgery at 12 noon. We were bumped all afternoon for more urgent surgeries and she didn't have hers until 7:30 that evening. That really sucked bad since she was only 2 and was soooooooooo thirsty and hungy. But, she is fine and if I was in a horrible car crash and need emerg surgery, I should think I'd be put ahead of tooth extractions.

2. We do pay a lot of income tax to pay for our healthcare system, but once you are so used to it, it just becomes normal, KWIM? The taxes are deducted from your cheque and you never see it, so you dont' ever count on that part of your pay. I'm in BC and we do pay healthcare premiums, $108 per month for a family of 3 or more, $76 for a family of 2 and $54 for a single person. Although, if a family's income falls below $28,000 per year, this premium is reduced or eliminated all together for lower incomes. This premium covers all doctor visits, diagnostic tests, hospital visits, stays, surgeries, childbirth etc. You don't pay anything out of pocket for a hospital stay unless you want a TV, phone or private room.

You can purchase "extended benefits" from a private company, or many workplaces offer it as a benefit. This would include Rx coverage, vision, dental, physio, chiro, massage etc. If I were to purchase this privately for me, my DH, and two children, it would cost us about $130 per month, but this is tax deductible.

Many people can get by just fine on the provincial health, which I listed above.

Please let me know if you have any other questions about Canadian healthcare. I have worked in the public/private healthcare system for 12 years now (not as a nurse, but as a medical secretary) :)

I think for me personally, what I like best about our system is that you won't go bankrupt for medical reasons (or very unlikely you would). There is NO WAY my family could afford some of the health care premiums I hear about in the US (like $800 per month for a family for BASIC, BASIC coverage). Also, having good and affordable healthcare insurance should not equal good employment. I am sure there are many lower-middle to middle class Americans whose employers don't offer health care, or if they do, it's way too expensive for the regular citizen. It seems like only the very poor are taken care of by the gov't and the well off to wealthy can purchase a good plan. In Canada, you are covered whether poor, middle class, rich, employed, not employed, disabled, etc. If your province charges healthcare premiums, but your income is below a certain amount, you pay less or not at all.

I would take Canada's health care system, as flawed as it is, over the US any day!!

FireStarterRN, BSN, RN · Dec 30, 2007

Thanks for the great posts! It sounds like a good system.

One problem in America is that we are brainwashed from day one that we are "The Greatest Nation on Earth". We are a great nation, hopefully great enough to learn from Canada about a better way to provide healthcare.

KING ARTHUR · Jan 2, 2008

I hope you don't mind me joining in this very interesting discussion. I don't live in Canada but in UK. As Canada's healthcare system is closely patterned from UK I personally would say there are pros and cons in having a free healthcare. My own personal view is I would favor the American healthcare system or simply without leaving UK paying private medical care.

My wife has a condtion called Wolff Parkinson White Syndrome or (simply irregular fast hearbeat). My wife is also a nurse and although has been asymptomatic had some few attacks while working and been in A&E needing treatment with various cardiac drugs. She has already been waiting for her appointment last year from her cardiologist for possible cardiac ablation but unfortunately has been cancelled 3 times. This is a very life threatening condition and without ablation she may suffer more serious attacks as this condition is very unpredictable. We would rather have it treated and sorted as soon as possible that's why we are considering private medical insurance or even going abroad to have it treated like many other Brits who goes to Asia to have their treatment done.

I know that paying private medical insurance is very expensive in this country or in America but I would rather pay knowing that I could be seen immediately and treated. It could be cheap or free but it might be too late.

globalRN · Jan 5, 2008

Canadians have an option of going abroad to have private medical care.

I have worked in Hong Kong, Canada, and did my masters in the US.

Canada still has a very good system overall but there are many abuses

Our system is stretched to the limits....we get many geriatric patients dumped in

emerg...as in 'we can't cope at home so here we are...take care of our acute problems(sometimes, there aren't any acute problems other than difficulty coping) and then the acute care system

has to find homes for these patients who can't go home and 'live' in acute care beds until

alternative appropriate placement is found for them.

My biggest beef is the sense of entitlement some patients have or the families that unrealistically

expect personal phone call updates on 'mom or dad' on a daily basis!!!

With the aging of our population...and the stretching of resources...I can't see how long we can keep the system going

lupin · Jan 8, 2008

This discussion is very interesting for me right now. I am an American nurse and have just finished watching the Michael Moore film "Sicko". While I am not a huge supporter of Michael Moore's, I did feel that the movie showed some very interesting points about the US healthcare system. However, I find it very difficult to travel right now and experience these socialized healthcare systems for myself. A lot of what the Canadian nurses were stating as problems or faults with their system seems related to a lot of the problems I observe over here.

Our "Baby Boomer" population is getting older and they are needing a lot more medical attention than what I see our elderly population needing. Healthcare is very expensive here but I see a lot of people who smoke, drink, have a bad history of drug abuse or just live really hard lives without obtaining health insurance complaining about the system here. We also have the problem of families not understanding the quality of life that they put their incapacitated family members in when they extend life-saving measures or insist that they take "Mama" home after hip surgery when Mama is a 200lb confused 90yr old woman who can't remember that she can't get up by herself. Then we are treating caretakers for their health concerns and Mama for her rebroken hip.

I can say with all honesty I don't think that the health care system is the only problem. We Americans are too impatient to wait for outpt treatments, too lazy to go to health education and community education classes (oh yes they do teach them here), and too selfish regarding our "lifestyles" for a socialized healthcare system to work here. As an Iranian doctor I work with put it, "This is a capitalist nation. You can not put a socialized system in a capitalist nation and expect it to work."

I also don't trust our government to set up a truly socialized system. I see a lot of ways to make more money off of us using that as a front than I do of them actually taking care of the population. My hope is to educate my generation and my kids' generation regarding better choices and personal responsibility for themselves and their health. Maybe in thirty or forty years we will have a better bill of health than our parents and grandparents do right now.

FireStarterRN, BSN, RN · Jan 9, 2008

thanks for the interesting imput!

loriangel14, RN · Jan 9, 2008

That was avery insightful and candid post.Thank you.