Friday, April 29, 2011

A Dissatisfied Customer

Thus far, the Canadians I've actually spoken to have been quite happy with the health care system here in British Columbia. So I have to admit, when I was on the Aquabus from Granville Island and I overheard a woman of a certain age talking about having been ill lately, my ears perked up thinking I might have found my first dissatisfied customer. In the US, I generally find that the more someone has had to use their health insurance, the less satisfied they are.

Sure enough, I engaged Aquabus Lady in a conversation and when I asked her if she'd had any problems with the health care system, she said emphatically, "Yeah. Plenty!" For the next couple of hours (in a conversation weird enough that I shan't begin to try to describe it) I tried to sort through a complicated set of complaints ranging from angiomyolipoma to high blood pressure and bipolar disorder.

When it came down to it, I identified three, maybe four issues:
1) Misdiagnoses
2) Lack of coverage for acupuncture, holistic therapies, and therapists other than psychiatrists
3) Difficulty getting her own General Practitioner
4) The need for a GP to get a referral to a kidney specialist or a psychiatrist

With respect to the misdiagnoses, Aquabus Lady was very unhappy about having been diagnosed with bipolar disorder, asserting she simply had situational depression. Hmmm. After spending, I kid you not, roughly two hours with her, Dr. Joan Pirkle Freud thinks she has some big problems. Bipolar disorder? Maybe, maybe not.

The other misdiagnosis was mistaking angiomyolipoma for renal cancer. I have it on good authority (Wikipedia) that it can be difficult to distinguish between the two. In any event, when I asked her whether she thought this misdiagnosis was the result of poor quality care or an unwillingness to do proper testing, she said no. Her opinion was that she got topnotch care for her kidneys.

With respect to complaint #2, it is true that acupuncture, chiropractic, naturopathy, and therapists other than psychiatrists are only covered for low-income patients with the government Medical Services Plan. In order to cover these services, as well as prescription drugs, many British Columbians have what they call extended health insurance coverage either through their employers or purchased privately.

Aquabus Lady wished a mental health practitioner other than a psychiatrist would have been covered by the Medical Services Plan since she did not have extended health insurance coverage. She was displeased about being prescribed psychotropic medication by the psychiatrist. Quite understandable.

As far as having difficulty getting one's own General Practitioner, many GPs in Vancouver are not accepting new patients at any given time. Apparently, lots of people go to clinics where they can see whatever GP is available at the time of their appointment. This sounds similar to going to an urgent care facility in the US.

Aquabus Lady also complained that she needed to get a referral from a GP in order to see a specialist. This is similar to the requirements at HMOs and some PPOs in the US. It certainly can be inconvenient. According to other Canadians I have talked to, once a patient has received care from a specialist, no GP referral is necessary.

So Aquabus Lady definitely has some legitimate complaints. Lack of coverage for holistic therapies, and the need for referrals to specialists are complaints we often hear in the US as well. Next time I'll tell you about the roundtable discussion on health care I had at the nail salon.

Friday, April 22, 2011

Going Broke Getting Meds: Location, Location, Location

"Friends held fundraisers, she scrounged anti-nausea medication ($23 a pill) from other patients...When her cancer treatment was done, Ms. Easley was $26,000 in debt. Twelve years later: 'I’m all clear of cancer, but I’m still paying for my cancer treatment'" -- The Globe and Mail

Still curious about what happened when Canadians had high drug costs, I asked my cousin Catherine who has lived in Canada for many years. She showed me an article in The Globe and Mail entitled, “Breaking the bank to stay alive”.

Sure enough, there it was. In some provinces, the lack of a government prescription drug plan can cause hardships similar to those we hear about in the U.S.

The article tells the tale of a young woman named Julia Easley in New Brunswick who was diagnosed with Hodgkin’s lymphoma and did not have private prescription drug insurance. All her physician visits and hospital care were covered by the government plan. However, the medications she needed to take while not in the hospital were not covered. Friends held fundraisers for her but by the time Ms. Easley was finished with her cancer treatment, she was $26,000 in debt.

In British Columbia and several other provinces, Ms. Easley would have had most of her prescriptions covered. In fact, since she had just graduated from college and probably wasn't making much money, she would have had 70% coverage of her medications until she had spent 2% of her income and 100% coverage after that through British Columbia's PharmaCare. But in New Brunswick, there is essentially no public prescription drug program and she was out of luck.

Cousin Catherine was quite reticent about sharing this newspaper article with me. She’s a big fan of the Canadian health care system. “Would you like to go get coffee with my pharmacist friend and me on Friday?” she suggested, hoping to present a more positive side of the picture. Sounded good to me.

Friday rolled around and I arrived at the appointed time at the crowded little deli out in Point Grey. I hastily greeted Catherine, ordered up a London Fog (my new favorite tea preparation), and within a few minutes, Safouh, the pharmacist, and I were settling into our interview.

I got straight to the point: Did he have customers who couldn't afford their medications? His answer was no.

I mentioned the problems with affording prescription drugs in other provinces and the proposals I had read for creating a national catastrophic drug program. Did he think there was a real possibility of enacting such legislation? Once again, his answer was no. Too expensive. Not going to happen.

Safouh brought up the fact that most drugs cost considerably less in Canada than in the US. We've all heard about this, as in US seniors going to Canada to buy their prescriptions. In order to get some exact prices on a couple of randomly selected drugs, I followed Safouh back to his charming, old-fashioned neighborhood pharmacy.

What about the brand name cholesterol drug Lipitor? A hundred tablets cost $184.43 at Safouh's pharmacy. I called my old-fashioned neighborhood pharmacy back in LA, and found the price of a hundred tablets was $424. For Trazadone, a generic form of the anti-depressant Deseryl, $33.26 for a hundred tablets in Vancouver - $85 in LA.

The customers started lining up at Safouh's pharmacy counter and I hit the road. My impression of Canada's prescription drug situation? In many provinces good but for the country as a whole, room for improvement. My impression of the US prescription drug situation? Don't get me started, honey.

Saturday, April 16, 2011

What’s Not Covered: Canadian Prescription Drug Insurance

On my way flying up to Vancouver, my seatmates and I had gotten on the subject of health care services not covered by the Canadian health care system. The item that raised the greatest concern for me was pharmaceutical coverage.

My understanding of the situation was pretty hazy so I decided to take a trip to the Urban Fare Market downstairs from our condo to talk to the pharmacist. Well, I didn't actually take it up with the pharmacist since he looked perpetually harried, as is so often the case with pharmacists. But there was an employee who turned out to be a 4th year pharmacy student doing some sort of internship and he seemed to have plenty of time to answer my questions.

I had come away with the impression from my friends on the plane that people got their prescription drug coverage through private insurance purchased either by individuals or employers. That turned out to be partially correct. But my pharmacy intern friend told me there is, in fact, a government program in British Columbia called PharmaCare that provides some prescription drug coverage based on income.

At this point, the intern stepped out from behind the desk, took me aside and gave me a quick education about the Canadian health care system...

There isn't just one Canadian health plan. Each province has a different health care plan. They are all a part of Canadian Medicare, which stipulates a few general requirements all the provincial plans must fulfill. In British Columbia, all legal residents are covered by the Medical Services Plan (MSP), which covers all medically necessary care provided by doctors and hospitals. There are premiums for everyone who makes more than $22,000 but no deductibles or co-payments. The MSP is a single payer plan, meaning it is the only insurance plan.

Everyone who is covered by the Medical Services Plan is also covered by PharmaCare. For folks who earn less than $15,000 per year, all their prescriptions are free. For everyone else, there is a deductible based on income, which must be met before the government starts covering 70% of the price of medications.

After folks have spent a certain amount out-of-pocket, medications are 100% covered. The amount a person has to spend before the 100% coverage kicks in is also based on a person's income.

For example, an individual or family with a net income of $50,000 has a deductible of $1500. After they spend $1500, their prescriptions are reimbursed at 70%. Once they have spent a total of $2000, the government covers 100% of their prescription costs.

This is where the private insurance may come in. Some employers provide private insurance that picks up the out-of-pocket expenditures. Evidently, this was the situation for the folks I met on the plane. And sometimes individuals decide to purchase private insurance on their own. Depending on the plan, private insurance may also cover other services not picked up by the Medical Services Plan such as physical therapy, chiropractic, and dental services.

Now this brings up the question whether folks who don't have private insurance can end up unable to afford the prescriptions they need. This is a scenario that is not terribly uncommon in the U.S.

I asked my pharmacy student buddy whether people come into the pharmacy who can't afford to buy their meds. His answer was yes. He said if the problem is that the prescription is for an expensive, non-covered medication, the person could qualify for Special Authority coverage. If somebody is just waiting for his or her next paycheck, the pharmacy can advance some medication. And of course, many prescription drugs are far less expensive in Canada. However, he said that even in Canada, there are prescriptions that can cost $1000 or more.

At last my intern friend had to get back to work. But I’m going to continue enquiring about the prescription drug situation. It appears that even in Canada, the pharmaceutical industry scores on this one.

Friday, April 8, 2011

An American in Vancouver: Canadian Health Care

Thanks for stopping in for my grand opening of Health Care On Location!

This blog came about because I'm a health care geek in Vancouver for an extended stay. My husband is a regular on a new TV show that shoots in Canada so I have come here to be with him.

He's worked here a number of times since the late 1980s and I've always made a point of asking Canadians what they think of their health care system. For many years, I never heard a bad word except for the physician's wife who thought her husband should make more money.

So I used to be utterly convinced that the things we heard in the U.S. about problems with the system were strictly free marketeer propaganda. But the last time I was in Vancouver, about four years ago, I heard some negative reports.

Consequently, I decided to make a project during my sojourn here of recording the comments of Canadians of all walks of life regarding their health care system. I wrote up a number of these conversations, sent them out to my mailing list, and began toying with the idea of expanding the project into a blog about health care systems in various countries around the world. After all, I had heard so many people in the US hold forth with great authority about how health care works in Canada or in Europe. And most of them, as it turns out, don’t really know what they’re talking about. So without further ado, here’s the first installment of Health Care On Location…

As I sat on the plane flying up from Los Angeles, I began chatting with my seatmates. It turned out they were both Canadian citizens. So I decided to begin my project with a random sampling of two. Of particular interest was the woman who had duel citizenship, Canadian and U.S. She was a 59 year old middle class educator whose first words when I began my questions were ...

"Americans are stupid when it comes to health care."

In the thirty years she has lived in Canada, her family has had to use the health care system rather extensively. From the time when her daughter was four years old and she had idiopathic thrombocytopenic purpura (low platelet count with no known cause) to her husband's bout with cancer, she always felt they received high quality care with no delays. OK, Canadian health care scores 1.

My other seatmate was a 32 year old sales manager for Minolta. He first wanted me to explain the new U.S. health care law, the Affordable Care Act. A half hour later, I had given him a brief outline of the plan with its complex ifs, ands, and buts. Then he wanted to know what the taxes are on someone earning $100,000 per year. I thought, "Ah, healthy young man resentful of high taxes." But he surprised me by saying:

"I'm happy we're paying higher taxes because we're receiving better services."

I kid you not! His mother is a nurse and he had comments about nursing shortages and the problems hospitals have because of government budgets. But ultimately he said, "If you compare us to the U.S. we're really lucky." I had the impression he hadn't had any major health problems but he too had no complaints about waiting times or quality.

An added plus -- The young man lives a few blocks from our apartment and has offered to show me around Vancouver!

Well, that's all for now. I guess Canada scored 2 for today. Next time, I'll tell you what I learned about the health care not covered by the plan the government provides.