Question for Canadians/Europeans

[Alex C.]

At my dialysis center, there is a technician who told me a story about a dialysis center near us, that happens to be the closest center to the Canadian border. He claims that they have a Canadian patient who comes over to dialyze 3x a week, and pays CASH, because OHIP won't continue his treatments after age 70. He also claims that "many European countries" also take you off dialysis once you reach some per-determined age. Is this true? If so, please, post some specifics.

Frankly, I think this guy is probably just some "old crank", but I wanted to ask, in case there is any truth in his story.

[justagirl2325]

Ontario here, on OHIP and I've never heard of such a thing.  At our local hospital (which is where one goes for in centre dialysis as there are no treatment centres like the US has) there are many people over age 70.

What may be happening here is that he lives in a border community without access to dialysis and chooses to go across because Canada won't pay for his travel?

I can't imagine paying each time.  We went once to the US and it was $523 for one session.   

[Simon Dog]

We went once to the US and it was $523 for one session.

The price is all over the map here in the US.  My center gets about $245 since I went on Medicare.  It was getting $445 when I was on private insurance, and I've had clinics elsewhere in the US bill (and actually get paid) as much as $5050 for a single treatment when I was on private insurance.  And no, that five thousand is not a typo.

[monrein]

I don't believe this to be true...something is missing. Canada absolutely does not stop providing treatment at any age. Bunk and more bunk...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.

[iolaire]

...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.

I'm fully supportive of universal healthcare for the US.  But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland.  Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money.  So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...

[Simon Dog]

Socialized medicine does two things - it reduces the amount of treatment available, and forces everyone to get "average" access.

Those of us who are fortunate enough to get great access to top tier facilities through employer insurance and/or medicare are losers if the system gets socialized, as the current system puts us ahead of the uninsured, or people with fewer resources.  Those who now have below average access and get some of the appointments previously granted only to those who can afford them are winners.

Any change to the system will create winners and losers, and it is unrealistic to pretend this duality does not exist.

[Alex C.]

I kinda thought he'd been listening to certain "tea party" blowhards, and you people in Ontario have more or less confirmed my suspicions. I think next time he starts talking, I'll just tell him to not listen to Fox News so much....

[Riki]

Socialized medicine does two things - it reduces the amount of treatment available, and forces everyone to get "average" access.

Those of us who are fortunate enough to get great access to top tier facilities through employer insurance and/or medicare are losers if the system gets socialized, as the current system puts us ahead of the uninsured, or people with fewer resources.  Those who now have below average access and get some of the appointments previously granted only to those who can afford them are winners.

Any change to the system will create winners and losers, and it is unrealistic to pretend this duality does not exist.

This is confusing.... this just sounds like it gives everyone a level playing field... which, doesn't sound that bad to me...

I pay cash for dialysis when I go to the US... I get part of it back when I come home.. When I went to New York in June, I paid $600 per treatment.. anything else besides the treatment itself was extra... I had to take my own bandaids, and the techs didn't know how to use the gelfoam that I brought

[Simon Dog]

This is confusing.... this just sounds like it gives everyone a level playing field... which, doesn't sound that bad to me...

I've worked my entire life, and continue to work a 30 hour schedule while on dialysis.   I have no interest in a "level playing field" granting equal access to those who have sucked off the public nipple their entire life; birthed babies at 15 and collected welfare/SNAP/WIC/EBT checks and not even tried to contribute to society.   

My point was that a "level playing field" as you call it will create winners and losers; it will not simply elevate everyone to the highest standard of care those who can pay for it now get.  "Level" will mean a reduction in standard of care for some.

Someone once said "From each according to his needs; to each according to his abilities".  In fact, he wrote a manifesto 

anything else besides the treatment itself was extra

Every dialysis center I've dealt with includes the bandages with the treatment as part of the base charge.   They don't include special bandages like the ones you bring, or antibiotic ointment like Mupricin.    Drugs such as EPO are billed as a separate charge item.  Plus, you've been in this game long enough to know you have to watch the techs to make sure they get it right.

[noahvale]

*

[monrein]

I'm not sure that there is any such thing as a level playing field anywhere in life let alone health care. What I can say about my experiences with the Canadian system is that it has served me and many others very well. I have done home hemo in both Ontario and Nova Scotia and although Nxstage is not available to us, home machines most certainly are and home hemo or peritoneal is both encouraged and widely supported. Living in remote or rural areas, no matter the country, will never be the same as a larger urban area. I felt underdialyzed after my first transplant failed and within a week I was put on five days a week instead of three and felt somewhat better. I have had two transplants, one from a cadaveric donor and one from a living donor who is from the US but who came here to donate. Is our system perfect? Of course not. However in my experience we do quite well for the largest number of people and I am extremely grateful to live here. I too worked hard and as much as I could but know that not everyone can do so for health reasons and this does not make them slackers or less worthy than me. It makes me one if the lucky ones in ever so many ways. There are indeed differences between provinces and most likely this is true also for states in your country.

I know from my personal experience far more about the Canadian system than I do about the American one and am always happy to hear about anyone who feels that they are getting good care wherever they are. I'm always a bit surprised however by some of the things that I hear about the Canadian system that bear no resemblance to what I have encountered here in Canada since I first started dialysis in 1980.

[Alex C.]

Thanks for your input, Monrein. My father's ancestry is Franco-Quebecois, and we have family members who do live in Canada, although the Canadian family member I most often talk with is a cousin form my mom''s side of the family. I will probably send you more questions, as I have them.

FWIW, despite all the right-side glorification of our health care system here in the US, we still leave a full 12% of our population COMPLETELY uninsured, and have a chaotic clown-car race of competing and infighting insurance companies to cover the rest of us who are not on public insurance. Whereas in Canada, any facility knows that your bill will be payed by the one and only health care provider, here, it takes an entire department of collections agents to figure out who will pay which piece, and at what rate, and at what percentage, and then to send out the bills, wait, and collect some of what they are owed. It's for this reason that we pay MORE per person, and yet receive LESS health care per person than in ANY developed country in the world. We pay as much per person for health care as they do in France, yet we don't get any of the elaborate and inclusive extras that they get, but we DO get thousands and thousands of collections agents a place to work every day.....

[Simon Dog]

Dialysis may be the one level playing field area of medicine in the US - everyone gets the same treatment (as CMS standards are also followed by private insurers) at the mediocre level that CMS has considered "adequate".  Remember, the standard is "adequate" treatment for everyone, not "optimal".   "Adequate" is why in-center is only 3 days a week instead of 3.5 days, and why there is resistance to giving you a bigger filter than the one that "adequately" meets goal.

Now, would you want a surgeon who is "adequate" or one who is "excellent"?

[Riki]

So, Simon, I have to ask, are you saying that people like myself, who have been ill for the majority of their lives, and are unable to work because of it, unworthy of the same treatment as you get?  Don't you think we should all get the treatment we need, regardless of how much we paid into the system, or if we are able to work a full time job?

Yes, I understand that it's not a level playing filed across the country in Canada, however, I get the same level of treatment as my neighbor, even if I'm on welfare and he's a millionaire.  That's what I meant about a level playing field.  Having money, at least in this province, doesn't mean you get better treatment than someone who doesn't have money.  There is no "shopping around."  Everyone goes to the same place.  If you want better treatment, and you have the money, you donate your money to the hospital so they can get better equipment, and then everybody gets better treatment.

[noahvale]

* 

[monrein]

So Noahvale, are you thinking that we have no choice or say or input over which doctor we see? This has not been my experience. When I need a specialist, I get a referral from my family doc or my nephrologist or gynaecologist or whatever. Then, if I find out during my research that there is someone that I would like to see over the one I'm referred to then I say so and I can go to them. I had a back surgery a number of years ago and asked for a surgeon that I had heard very good things about. My husband needs a knee replacement and he will check around and request a referral to a specific surgeon. Now of course, one might have to wait to see the surgeon of choice if he/she is really busy (I imagine this is also the case in the US) but no one tells me who I have to choose. I have friends who have been dissatisfied with their family doc and they have asked around, found another who is accepting new patients and changed over. I live in a big city and as a result feel that I have a lot of control over my care. The same may not be true for a person living in a remote area, smaller town etc but that is likely true where you are also. The government does not tells patients who their doctor must be and I'm not sure why you have this perception.

[PrimeTimer]

I thought the money collected from those who "pay into the system" is distributed amongst those who need care, including the person who paid into the system. Imagine what it would be like if no one could or would pay into a system or, if there weren't enough people to collect from even though everyone needs care. As for waiting lists, personally, I would not want to have to wait very long if my doctor suspects a brain tumor or MS and needs to see the results of an MRI before deciding on the next course of action. And I don't want someone deciding for me as to whether or not I can or should be on a waiting list. I think the critical word here is "choice".

[noahvale]

^

[monrein]

I live in Ontario and I live in the big city of Toronto. Of course there are differences between provinces just as there are differences between States. Northern Ontario is not densely populated and obviously not always well served. I suspect the same can be said for many parts of your country and of individual states.

Prime Timer, our health care system is funded by our taxes and we don't have the choice to opt out of those any more than you do. Our government is pretty insistent on that, kinda like yours is.  Personally I pay them happily. Emergency situations are dealt with pretty immediately. A suspected brain tumour or other emergency would not be on a waiting list. You could look up Canadian Heath care system on Wikipedia if you are really interested in how things work here. I have a Health card that I present to doctors or hospitals or medical labs when I receive care and that's it. This is in fact how things work in many parts of the industrialized world with some differences of course and some do better than others in particular areas. Canada's system does not include medication generally except for seniors but here in my province we have a program (Trillium drug program) that transplant patients apply for . It is geared to income and therefore my yearly deductible amount depends on my income in a given year. I find this to be fair and I am always very happy when I have to pay for more of my meds because it means that I've made more money that year.


Our system works approximately like your Medicare I think except it applies to all of us not just seniors (or people on dialysis).

[PrimeTimer]

I did some reading on wikipedia about Canada's health care system. They had entire sections on... how prescription medications, among other things, including dental and mental health care not being covered, long wait times (but then they try selling you on the idea that sometime longer wait times can actually benefit a patient...say wha???), you have to re-qualify for care if you move from one province to another and sometimes the re-qualifying period is 12 months...yikes!. Wiki also included the fact that Canada's health care system places restrictions on privately funded health care (sounds like punishment to me) and a section about Canadians having to go to the US for care and (hold onto your seat for this one) not everyone gets the same level of care.

[PrimeTimer]

So Noahvale, are you thinking that we have no choice or say or input over which doctor we see? This has not been my experience. When I need a specialist, I get a referral from my family doc or my nephrologist or gynaecologist or whatever. Then, if I find out during my research that there is someone that I would like to see over the one I'm referred to then I say so and I can go to them. I had a back surgery a number of years ago and asked for a surgeon that I had heard very good things about. My husband needs a knee replacement and he will check around and request a referral to a specific surgeon. Now of course, one might have to wait to see the surgeon of choice if he/she is really busy (I imagine this is also the case in the US) but no one tells me who I have to choose. I have friends who have been dissatisfied with their family doc and they have asked around, found another who is accepting new patients and changed over. I live in a big city and as a result feel that I have a lot of control over my care. The same may not be true for a person living in a remote area, smaller town etc but that is likely true where you are also. The government does not tells patients who their doctor must be and I'm not sure why you have this perception.

Obviuosly, you live in a wealthy, densely populated province.


"Already a destination for its beaches, palm trees and Disney parks, Florida can now add medical tourism to its list of attractions as more and more Canadians visit for surgery.

Long wait times are increasingly driving patients south, including two Albertans who underwent surgery on the same day last month, and commiserated about feeling abandoned by an ailing system back home."

http://www.calgaryherald.com/news/calgary/Long+Canadian+wait+times+send+patients+south+surgery+Video/9702357/story.html


"When it comes to waiting for health care, Canada is last in line
A major international survey says Canadians wait longer for health care"

http://www.macleans.ca/politics/when-it-comes-to-waiting-canada-is-last-in-line-2/


From a different perspective.  Comparing Canada to other universal-access health care programs.

http://www.huffingtonpost.ca/nadeem-esmail/canada-free-health-care_b_3733080.html


Those who have the longest wait times in the States, are those who get care through the Veterans Administration.  Ironically, our country's version of a single payer, government run healthcare system.  Plus, veterans do not get to go outside the VA system unless the needed services are not offered or they wish to pay out of pocket.

I hope you are a voter. 

[PrimeTimer]

Per a study titled "The Effect of Wait Times On Mortality in Canada" released on May 20, 2014 by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank, Canada's growing wait times for health care may have contributed to the deaths of 44,273 Canadian women between the years 1993-2009.   

[Riki]

I don't think wait times are any different in Canada than the US... if something is needed, it's done... I waited a week for my gallbladder surgery, but that was my choice, because the first surgeon that saw me was nervous.. he didn't really want to touch me because I was/am a dialysis patient.. he was the weekend surgeon.. I waited a few days for the weekday surgeon to see me.. he was  younger, and less nervous.. then I had to wait a few extra days until there was an opening..

[kristina]

...sounds a bit like some of the bizarre and incorrect myths that were perpetrated in the U.S about the Canadian medical system when much fear mongering about " socialized" medicine was at its peak.

I'm fully supportive of universal healthcare for the US.  But recently I've learned there is zero space for holiday dialysis in Ireland until June at the earliest. So that makes me wonder if centralized medicine is the driving factor and they are under built for dialysis in Ireland.  Also my coordinator told me a NHS center in London was closed down because the NHS is trying to get everyone on home hemo to save money.  So I could see how that type of situation like in Ireland and the UK could be turned into fear mongering...

Hello iolaire London here... I have not heard of a London dialysis-centre being closed down,
but there again I don’t really know how dialysis-centres in other London districts cope and what they (have to) do or plan ...
Concerning home-hemo: I have tried -  from the very start - to „remain independent“, get my training and be able to „do“ home-dialysis,
but I was told it would be much better for me to have my dialysis-sessions in a dialysis-centre
because of my complicated health-history and my forthcoming transplant...
... and I also could be much better medically observed in a dialysis-centre... Mind you, that was five months ago... 
Best wishes and good luck from Kristina.

[monrein]

I really can only speak about my own experiences with the health care system here Prime Timer, and I do wish that I had not needed to use the system as much as I have.  Are there problems here that we need to address? Yes. And furthermore the issues will change over time. Our aging population will make increased demands on the system and I think that we need to learn from some of the other systems around the world. Most of my family live in Florida but I came here at fifteen and like it here very much. I've also lived in France and I held a US passport for most of my life. We all speak from our experience with the various systems that we encounter and within my family in the US, some are happy with their care while others feel that they pay an enormous amount for not very much really. They all seem to think that what I have here is very good indeed. Our system is not perfect and like everywhere we as patients must advocate for ourselves, do our best to stay healthy, educate ourselves about our medical issues and do what we can to contribute to improvements in our communities and our infrastructure.

You hope that I am a voter? . Of course I am. I consider my right to vote both an obligation and a privilege.