2019 Video Interview: O Canada! - Dr. Monika Dutt, Canadian Doctors for Medicare
Saturday, October 19, 2019
Afternoon Plenary, 2:20PM-4:25PM
Dr. Monika Dutt, Canadian Doctors for Medicare
Questions for Dr. Dutt
I live with a chronic complex illness and I need to have physician continuity. I also have to take several meds and get infusions. It sounds like I would need to purchase supplemental insurance to get it covered, yet I already live in poverty due to my degenerative illness.
No, you would not need to purchase supplemental insurance. Your physician care would be 100% publicly funded, and all provinces have publicly-funded pharmacare for those considered low income. For example, here is British Columbia’s Fair Pharmacare program.
How is medical school paid for?
Tuition in Canada ranges from about $8,000 CAD to $30,000 CAD for Canadian residents, depending on the university. Medical education subsides are paid by the provincial governments and vary by program and province. Tuition for international students is higher. Note: Tuition may seem low, compared to US universities, but there has been a steady increase over about the last ten years, particularly after provinces relaxed regulations on how much universities could charge.
How does worker’s comp function with the medical system in Canada?
Worker’s comp is a separate funding bucket, just like in the US, but care is delivered by the same physicians and hospitals as for Medicare. Workers comp is insurance for injuries and illnesses. It operates independently and is funded by employers. Coverage is generally mandatory but certain industries are exempt.
Are workers injured on the job provided with treatment through the National Health Services or is worker’s comp a separate system?
First, Canada doesn't have a National Health Service, per se. Unlike the UK, which has a National Health Service that funds care and owns the delivery system, Canada has a publicly funded but privately delivered system. Unlike the NHS in the UK, the government in Canada does not own the care delivery system.
Second, the care for injured workers is funded through a separate workers comp system.
How can a US citizen travel and take advantage of the Canadian healthcare system?
A US citizen could pay out-of-pocket for any services available in Canada. An insured US citizen could potentially claim back those expenses from their private insurer. US Medicare beneficiaries traveling between Alaska and another state would be covered by US Medicare for emergency services while passing through Canada. US Medicare beneficiaries whose closest hospital is in Canada, rather than the US, maybe covered by US Medicare.
Does Canadian medicare reimburse the same to doctors and hospitals in every province [and territory]? Equal reimbursement or different by province?
Each province and territory has its own fee schedule for physicians. Each province has its own payment system for hospitals, mostly global budgets.
In the last decade or so, has there been any effort to have national healthcare to replace the provincial-based healthcare plans?
No. The organization of Canada's health care system outlined in the Canadian Constitution, and health care falls under provincial jurisdiction. We will likely never have a system like the National Health Service. We have several states working on legislation on the state level.
What was the most significant strategy that made the campaign in Saskatchewan a success?
Political will and courage on the part of the Premier of Saskatchewan, Tommy Douglas.
Do the Canadian physicians feel they are not adequately paid for their services?
Some physicians may feel they are not adequately compensated. Others feel they are paid too much. Others are happy with their salaries. Just like Goldilocks. Physicians are still the highest paid profession in Canada.
What is the percentage rate of approval?
Not sure if you mean approval of Medicare or approval of claims! Medicare: The vast majority of Canadians approve of the health care system. An 2012 survey found “universal health care is almost universally loved, with 94% calling it an important source of collective pride." Claims: If the service/amount being billed to the government by the physician is covered under the fees that have been negotiated, approval is almost certain. Rejection of claims is rare.
Were there any unique issues for making the transition for First Nations people?
Generally, health care for First Nations and Inuit peoples is funded almost entirely by the federal government. A recent exception was the creation in BC of the autonomous First Nations Health Authority, which is explained here. However,for Indigenous peoples accessing care off-reserve, care may be provincially funded. There are variations, such as the First Nations Health Authority in BC that delivers care. Traditionally, the federal government has funded health and social services to Indigenous peoples at a lower rate than provincial/territorial governments fund the same services.
How many family physicians are able to do more for their patients than FPs in the United States? Specifically, how is additional accreditation through the Canadian college of physicians and surgeons offered in areas of pre- and post-natal care, anesthesiology, emergency medicine, addiction medicine, etc., and what does that mean to the overall value of a “generalist” in Canada with respect to serving their patients?
Family physicians, particularly those in smaller communities, offer a wide range of care including primary care, in-hospital care, emergency care, and obstetrics. There are “enhanced skills” programs, usually one year, in many areas including addiction medicine,anesthesia, global health, care of the elderly, low-risk obstetrics and many other areas, however most family physicians have not completed these programs. In Canada, family physicians are the gateway to specialist physicians and many other services.
During the Democratic debates, a major differentiation point is related to whether private insurance is still available. Do you think that private insurance is okay if only as a form of supplemental option, as long is there was no opt out?
Yes, supplemental private insurance is okay, and it’s also okay to “opt out” and not buy supplemental private insurance to cover dental, drugs, massage, chiropractic, eyeglasses, and things like that. Nobody is required to buy supplemental private insurance, though most employers provide it for their employees. Supplemental insurance is optional. Duplicate private insurance, conversely, is unlawful. Nobody is allowed to buy duplicative private insurance (which duplicates what is covered under Medicare).
Are doctors under single-payer paid less than doctors in the USA?
On average, no. Doctors in Canada are well-paid and among the highest income-earners in the country.
Is long-term care covered? Does it fund home and community services?
Long-term care funding tends to be split into health services and accommodation services. The health services component is usually publicly funded through a per-day amount (per diem) or a combination of global budgets and per diem, depending on the province. Accommodation services are generally funded by the resident through a co-payment; provinces tend to apply a means-testing process to adjust the co-payment amount.
Source: UBC, Long-term Care
What attempts, if any, are Pharma or other interests making to undermine medicare in Canada?
A recent report by the Canadian Federation of Nurses Unions showed that pharmaceutical and insurance insurance lobbying of government has increased dramatically as the push for a universal single-payer pharmacare program becomes stronger. Their efforts may be why, as of yet, the federal government has not implemented a program despite seeming to be supportive of the idea.