Ontario Health Care

Genghis Khan

Ancient Mariner
We've talked quite a lot about American health care.  Now I'd like to divert you attention to Ontario health care for the interested parties.  Ontarians pay 43-46 cents upon a tax dollar for health care.  Here is the state of it today.  I'll let you be the judge.  By the way, OHIP stands for Ontario Health Insurance Plan.

Long waits send patients to U. S. for care
For nearly three years, Brandon Taylor lived in agony with a herniated disc.

The now 22-year-old Hamilton student and his father, Stuart, were told open back surgery at Brandon’s age could be dangerous.

The wait to see a specialist who could help decide treatment was up to a year, they were told.
The best the Ontario health system could offer was prescription painkillers.

In August 2007, Stuart Taylor packed up his son and agreed to pay $28,000 in Florida for minimally invasive laser microsurgery.

The treatment worked for Brandon, now a fourth-year engineering student at McMaster University.

But father and son are embroiled in a bitter battle with OHIP to have the medical costs reimbursed.

The Ontario officials who decide whether out-of-country treatment should be paid by public health insurance say the Taylors broke the rules.

OHIP says they did not apply for pre-approval as required, and that the Florida surgery does not qualify as it is considered experimental here.

“Every single person I have spoken to, except OHIP, says I did the right thing,” says Stuart Taylor, who mortgaged his house to pay.

The Taylors are not alone.

Long waits, unavailable procedures and poor physician access are driving record numbers of
Ontarians to seek treatment south of the border and sometimes overseas.

A Metroland special report on cross-border care shows:

•  A 450-per-cent increase in OHIP approvals for out-of-country care since the beginning of this decade, a period of explosive growth in new technologies and therapies not covered or available here. The province agreed to fund 2,110 procedures or treatments in 2001, and 11,775 last year.

• Patient demand has created a new breed of health-system navigators, known as medical brokers, who find U.S. options for the growing number of Ontario patients who elect to pay for medical services south of the border themselves.

Medical brokers negotiate discount rates with U.S. centres to get Ontarians faster diagnostics, second opinions and surgery.

Brokers say that for every patient sent south by the Ontario government, there may be up to 10 others who go — and pay — on their own.

• Ontario’s spending on out-of-Canada medical services has tripled in the last five years. Payments in 2010 will balloon to $164.3 million, from $56.3 million in 2005. The province said in last month’s economic forecast it needs to increase health spending by $700 million to cover “higher than anticipated” OHIP costs, including services outside the province.

While out-of-country spending is a small part of the $11 billion OHIP pays for all patient services a year, the increase is significant, Ontario’s health minister says.

“Are we looking at ways to reduce out-of-country? Absolutely yes,” said Deb Matthews, who became health minister last month.

Matthews says her ministry is taking steps to improve services and access across Ontario so fewer patients will need to go to the U.S.

At the same time, though, the ministry continues to negotiate preferred rates for Ontario patient visits to U.S. health centres, the Metroland investigation shows.

• Ontario has become a major contractor — a bulk buyer — of American health services this year.

Since spring, the ministry has entered into funding contracts with U.S. hospitals, imaging clinics and residential treatment centres.

It has these “preferred provider” contracts in place with about 40 American medical providers now — and is accepting solicitations from others. Contracts cover diagnostics, cancer care, bariatrics and adolescent behavioural disorders. The ministry says the agreements ensure “more immediate services for patients whose health is at risk.”

It has declined to release details of any of the agreements.

• The province does not track the number of Ontarians who cross the border for care on their own, never seeking government pre-approval or reimbursement.

But major U.S. medical centres contacted by Metroland — including Detroit’s Henry Ford Health System and the Mayo Clinic — say both government-funded and private-pay patient lists are growing.

The Mayo Clinic, which sees about 600 Ontario patients a year, says top reasons include wait times and diagnostic evaluations “when they’ve exhausted options in Canada,” says Mariana Iglesias of the Minnesota-based clinic.

OHIP’s pre-approved funding program for out-of-country care is supposed to fill gaps in health care for high-risk Ontarians.

But patients who use the system express repeated concerns — about the time it takes to get OHIP approval, and to appeal if refused.

“I really believe they make it as difficult as possible,” says Janet Nancarrow of Ottawa who is preparing for an OHIP appeal hearing for her 34-year-old daughter, Lisa, who is taking part in a clinical drug trial at the Mayo Clinic.

Her doctors and family say the trial is her only option short of end-of-life palliative care. With no outside help, Nancarrow said, she had to research precedent cases, find expert witnesses and keep up with enormous paperwork — all while accompanying her daughter back and forth to Minnesota for treatments.

“They shouldn’t put families through this,” she said.

• Ontario continues to struggle with wait times. This month, almost 140,000 people are on wait lists just for CT scans and MRIs.

• Wait-time insurance policies have emerged as the industry caught on to public angst. While no industry figures exist to indicate the level of consumer take-up of the coverage, plans are available to reimburse costs of private treatment when policyholders are forced to wait more than 45 days.

Ontario says it has made strides to reduce waits for the priority procedures it monitors. But the Ontario Health Quality Council — which the ministry set up to review provincial progress — says more needs to be done.

“Many Ontarians still wait too long for urgent cancer surgery, MRI scans … and specialists,” the council says in its 2009 report.

Ontario NDP leader Andrea Horwath says the OHIP out-of-country surge has taken on momentum, and that government must stop the southbound flow.

“The government needs to reinvest the dollars that they’re shoving out the door to private providers of health care in the States, and invest that in providing services here at home,” she said


http://www.hamiltonmountainnews.com/news/article/195693
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Wait time snapshot

Ministry of Health figures show the number of people on official wait lists, on Nov. 1:

MRI scans: 74,867

CT scans: 61,506

Cancer surgery: 5,086

Hip replacement: 3,890

Knee replacement: 8,684

MRIs and CT scans have been among the most-requested U.S. procedures for years — due to long Ontario wait times and proximity to U.S. border-city clinics.

The numbers

Out-of-country applications pre-approved by OHIP 

2008-09: 11,775

2007-08: 8,885

2006-07: 7,021

2005-06: 5,549

2004-05: 4,533

2001-02: 2,110

OHIP Spending on Out-of-country procedures*

09-10 — $164.3 million (estimate)

08-09 — $127.9

07-08 — $101.4

06-07 — $70.1

05-06 — $56.3

*Pre-approved by OHIP

Wait time insurance

What it is: A privately obtained insurance that allows Canadians who have excessively long waits for procedures to obtain services at private U.S. clinics.

What it costs: Monthly premiums for wait-time insurance range from $100 to $200 a month.

How it works: Typically, benefits kick in when a covered person is on a wait list for more than 45 days. Coverage includes costs for diagnostic tests and treatment for hundreds of medical conditions. Coverage is subject to terms and conditions of the particular policy.

Others go south

Ontario has two major agencies that sometimes send Ontarians south of the border for care.

Criticall: It’s a 24-hour, publicly funded emergency referral service for hospital-based Ontario physicians. It finds spots across the province for patients in need of critical care, last year handling 15,319 cases. About 400 of those went to the U.S. for cardiac, neurosurgery and other kinds of critical care.

WSIB: Workplace Safety and Insurance Board, Ontario’s public worker compensation system, approved about 100 claims for out-of-country hospital and physician services in 2008 for just more than $900,000.

Links

Ontario Wait Times: www.ontariowaittimes.com

OHIP pre-approval: www.health.gov.on.ca/english/public/pro ... roval.html

Health Services Appeal and Review Board: www.hsarb.on.ca

Ontario Health Quality Council: www.ohqc.ca
http://www.yorkregion.com/article/99820
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http://www.thespec.com/News/Local/article/681010
http://news.guelphmercury.com/News/article/567773
http://www.oakvillebeaver.com/opinions/article/288289
http://www.hamiltonmountainnews.com/news/article/195667
 
I think this article is written to prove that Ontario's health care situation is deteriorating, not to report on the fact that it is.
 
Would you explain that a bit better? I don't see the difference that well, sorry for misunderstanding.
 
Sure.
First of all, I'm absolutely not saying the article is wrong, but I do take issue with prejudicial writing.  When it comes to health care, people should be presented with facts, because any choice they make (from insurance, to choosing a candidate in an election, to whether or not to take their health care in- or out-of-country) is so critical to their well-being.

Prejudicial reporting says things like, "Brokers say that for every patient sent south by the Ontario government, there may be up to 10 others who go — and pay — on their own."  This is meaningless nonsense.  We have no statistics or facts, we just have the opinion of people who have a vested interest in Ontarians believing that the current system is broken.

The article is littered with these sorts of insinuations.  For instance, it suggests that increasing costs of Ontario dollars spent on out-of-country medical care is bad, and then suggests something is afoot when they report that Ontario is entering into plans to reduce the costs of sending people out-of-country, instead of Ontario being responsible by creating a viable alternative for people with critical illnesses and extensive waits.
 
I see what you mean. So best thing would be to get as many facts as possible, presenting the case from different perspectives.
 
Forostar said:
So best thing would be to get as much facts as possible, presented the case from different perspectives.

As always. ;)
 
Yes, and especially in health care.  I have some other issues, but I need to take time to write a comprehensive review.
 
Still I am interested in the figures GK gave us. But the picture would be more complete if we had some of those figures from other states or countries (plus the number of inhabitants).
 
They're not "real" figures.  It's raw data.  71,000 people waiting is meaningless if they put through 25,000 people a day, for instance (they don't, that's just an example).

I am hoping to run a comparison with Nova Scotia and with UK or France on the financial, time-based, and "real" cost with per-capita numbers.
 
Well Genghis? Any wish to continue this topic? Our reactions surely could give some basis, I assume.
You might be interested in the links I provided, where you can compare Canadian healthcare with European healthcare.
 
I have read that report Forostar.  The conclusions reached are not surprising to me, but it would be to most Canadians.  A cultural mythos persists here that "we have the best health care in the world".  The one finding of most interest to me is not the actual health care or even the expenditure but rather the statement that Canadians have a lower expectation of their health care system.  Compare that with the above quote.  Psychologists would call this "cognitive dissonance".

What puzzles me is why we're spending so much when much is not covered?  Consider the following.  When my wife was in the hospital, she was moved to a private room without her consent.  The hospital charged her $1,000 for this room.  Thankfully, her company covered the expense.  My most recent medical needs were as follows: dental, insoles, chiropractic.  None of these were covered by OHIP (Ontario Health Insurance Plan).  The costs to me seemed fair, but that's just a feeling as I have nothing to compare it to.  Dental was $120; my shoe insoles were $450, but the original assessment was covered by OHIP; the three chiropractic sessions were $30 each and lasted 15 minutes each.

Netherlands is consistently at the top or near as far as health care is concerned.  If you don't mind my asking, what are the taxes like and how much of the tax is going to health insurance.  Also, do you have a two-tier system like in France?

If you respond, you'll have to wait for a while for me to see it.  I'll be away for over a week.  ;)
 
Genghis Khan said:
The costs to me seemed fair, but that's just a feeling as I have nothing to compare it to.  Dental was $120;

It depends on what is was. Once I had a treatment of a couple of hundred (maybe 400) euro for a crown.
I got some of it back from insurance, but I don't remember how much it was.

Genghis Khan said:
my shoe insoles were $450, but the original assessment was covered by OHIP; the three chiropractic sessions were $30 each and lasted 15 minutes each.

I've no experience with that (yet).

Genghis Khan said:
Netherlands is consistently at the top or near as far as health care is concerned.  If you don't mind my asking, what are the taxes like and how much of the tax is going to health insurance.

This may sound stupid but I really don't know this, exactly. I do know that I pay more than 1000 euro/year premium, for my health care insurance. Everyone needs an insurance, but we can all decide how far we want to go with that, and for which category. I chose for an upgraded teeth-insurance. I pay more per month, but I also get more money back than someone who only has basic insurance.

Here you know what you get before you get an insurance. Important questions: can I choose all doctors, which hospitals can I go to. Health care is not only money, but also quality.

Genghis Khan said:
Also, do you have a two-tier system like in France?

Not sure. We have the possibility of collective insurances, e.g. via my job, or via a trade union. This is positive because like this I get discount.
 
Forostar said:
This may sound stupid but I really don't know this, exactly. I do know that I pay more than 1000 euro/year premium, for my health care insurance. Everyone needs an insurance, but we can all decide how far we want to go with that, and for which category. I chose for an upgraded teeth-insurance. I pay more per month, but I also get more money back than someone who only has basic insurance.

Knowing true costs for your health care is something I'd want to know regardless in which country I lived in.  Here, some things are paid with taxes and some out of pocket and some through work covered insurance.  The last one has costs as well.  For example, my wife's work covers her, and via marriage, covers me too.  But this must, I presume have short-comings.  Her company has a profit sharing plan, so that if the company does well, a certain percentage of the profits are shared amongst the employees.  I'm assuming that such benefits must be curtailed if the company spends too much money on health care.  I think this is the case with GM car company in the USA where they actually spend more money on health care than on steel.  (Can't keep from talking about USA, can I?)

Forostar said:
Here you know what you get before you get an insurance. Important questions: can I choose all doctors, which hospitals can I go to. Health care is not only money, but also quality.

Certainly.  

Roughly 850,000 people (out of 12 million) don't have their own family doctor or general practitioner (GP), but they can go to a walk-in clinic to see a doctor.  The walk-in-clinic doctors are actually GPs who take turns helping those without their own GP.  In these environments, the doctors are usually stressed, curt and sometimes down right rude.  I hold no grudges and do not blame.  The waits are much longer.  One cannot make an appointment, so you show up whenever and the wait is usually two hours long.  There was a brief period when I actually prefered this method as opposed to going to my family doctor.  (I think on the 100,000 Posts thread, I called my old family doctor "senile").  As far as hospitals are concerned, I can access any one of them in Ontario.  Hamiton, which is one of the poorest cities per capita in Ontario, actually has one of the best health care facilities.  Go figure!  The Hamilton Health Sciences are the city's biggest single employer.  If I'm in a different province, I'd have to pay and then file some sort of paper work with my province in order to get that money back.  I've never needed major health care outside the province.
 
Is there such a thing as personal responsibility anymore?

Health care costs are ridiculous, and its obvious why most cant afford it. But then again, most people cant prioritize their spending, and instead, buy new vehicles, a larger than needed home they cant afford, and the new hottest toys.
 
I know this is a semi-old thread but I could not resist posting this.  One of our politicians, Danny Williams, Premier of the Newfoundland and Labrador province had heart surgery in the States.  This is nothing new.  Our richer private citizens and politicians do this.  What is shocking is that when he went to Vancouver for the Olympics he was quoted as saying if his heart stops please take him over the border to Seattle.  You gotta love it when even the politicians do longer feel shamed slamming our health care in public.
More here.
 
Ontarians pay 43-46 cents upon a tax dollar for health care

That makes no sense.  Health care usually makes up about 20% of government spending and if 45% of income went on just tax healthcare the tax rate would be higher than 100%.

Nicola
xx
 
It makes sense because Ontario is badly in deficit. So, it's kind of a number that can mean whatever you want it to mean. You could argue that Ontario borrows all of the money for health care and spends all that money on education, etc.
 
I thought I would update this.

Soaring costs force Canada to reassess health model

TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.

Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.

British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.

And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.

It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.

"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.

"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.

"At some stage we're going to hit a breaking point."

MIRROR IMAGE DEBATE

In some ways the Canadian debate is the mirror image of discussions going on in the United States.

Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.

Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.

Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.

But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.

"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.

Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.

"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.

Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.

Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.

"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.

The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.

In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.

WINNERS AND LOSERS

The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.

"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."

Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.

"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"

But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.

"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."

($1=$1.05 Canadian)

(Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway)
 
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