I think everyone here knows that I am a big proponent of universal health care (UHC). I often read posts by Canadians (and people in other countries) saying how much they love their free-at-point-of-delivery systems.
But I belong to a Facebook group from a Canadian city just a few miles from here, and someone posted this:
I am type 1 diabetic, I have been since I was a child. I am going through a divorce and coverage is shady on helping me with sensors. I don’t have the money needed each month. I have applied for pharmacare help, however that takes months apparently.
Does anyone have any sensors: freestyle libre, G6 or G7 I could potentially pay for or be donated to me if you’re not going to use them?
I don’t understand. I thought Canadians were entitled to healthcare by virtue of being Canadian citizens; and that unlike our system in the U.S., they don’t lose coverage for life changes. I know that the provinces administer the national plan, but under the Canadian national health care system, why this person needing to ask for donations to get the sensors she needs? What if she had had an organ transplant? Would her access to anti-rejection drugs be endangered? What about drugs for other life-threatening conditions?
Have I misunderstood how the Canadian health care system works?
The best part: You get sick, go to a Doctor, referred to a specialist, many tests run, hospital stay with many procedures and operations, out-patient care: cost to you: ZERO
The Facebook quote in the OP is from someone looking for a donated continuous glucose monitor. Isn’t that something that’s nice to have but not something that’s necessary to monitor one’s glucose levels? Plenty of people are able to manage their glucose levels using the finger prick meters. The fact that Canadian health care coverage won’t pay for the CGM for this person really doesn’t say anything about how they’ll cover the really important stuff.
I’m not familiar with this particular detail, but the fact that the health care system does unconditionally cover the important (and expensive) stuff is a very important principle of how the health care system works. But as I’ve said before, they tend to nickel-and-dime on the small stuff. For instance, due to recent changes, annual eye exams are covered only for children under 20, seniors 65 or over, and those with specific medical conditions. Everyone else needing glasses needs to pay for the optometrist exam. OTOH, if you suddenly need surgery costing $100,000, no problem. Cost to the patient is zero.
The Canadian system (really a series of provincial systems with national guidelines) will cover the basics. What “the basics” are may vary, and will depend on negotiations between the province, doctors, and suppliers. It seems like coverage of continuous glucose monitors varies by province, with some provinces fully covering such monitors and others means-testing or requiring co-pays; it’s likely that your friend has lost private coverage through their husband, and lives in a province that doesn’t have full coverage.
Canadian drug coverage is complicated and varies by province. It involves a patch-work of public funding covering all hospital drugs, additional public funding with specific conditions administered by the provinces (specific medications or conditions, seniors programs, low-income programs), private insurance coverage, and out-of-pocket expenses. In general all drugs provided at a hospital will be free, prescription drugs that deal with conditions that are immediately life-threatening (chemo drugs, anti-rejection medication) will be free or heavily subsidized, and other prescriptions vary a great deal depending on which province you live in and what your age and financial situation may be. Most jobs in Canada provide some type of additional private insurance that includes drug coverage.
Exactly. Each province has variation on what is covered …the Feds deal out the money but the provinces spend as they see fit with certain core provisos.
My son had Type 1 diabetes and for a boy ….managed reasonably well.
Insulin pumps ( $4-6k ) were provided for each Type 1 person for no cost and a certain amount for the supplies.
Continuous monitoring was not covered. Likely would have been a boon to him when he was rebellious teen. Type 1 girls get anal about keeping their blood sugars perfect and rarely have issues
The word “basics” here is misleading, or might easily be interpreted in a misleading way to imply that only low-end stuff is covered. But a fundamental principle of health care in Canada enshrined in the Canada Health Act is that all medically necessary procedures must be covered, and must be provided at no cost to the patient. As I noted above, if you suddenly need major surgery that costs $100,000 or $200,000 or more, there will not be a problem if a doctor deems it medically necessary. I was in hospital for nearly a week several years ago with a heart condition and had surgery, and it cost exactly $0, and nobody had to pre-approve anything.
Where there’s wiggle room is in the exact definition of “medically necessary”, and the provincial health care systems tend to exploit that wiggle room by saying, “everything will be 100% covered if medically necessary, unless it’s a procedure so common and so affordable for the patient that we can save a ton of money by excluding it”. Like my example of eye exams for healthy adults. I’d sure much rather have trivial things excluded than having an insurance company intervene if I require expensive surgery and possibly deny coverage!
And another aspect of drug costs is that Canada negotiates prices for drugs on a national scale, so even if you don’t have a separate health insurance plan for drugs, you’d still pay a lower price than the same drugs in the US. So, people who are very poor may have trouble getting what they need, but most people can still afford their essentials.
ETA: for example, look at the costs of different types of insulin by county. Canadian cost is about 10% the cost in the US.
This makes me wonder how much inhalers are there. My freaking generic Albuterol inhaler is 50 plus dollars a month. I don’t even have a generic steroidal inhaler because it costs somewhere around 300.00 last I checked with insurance.
OK, I googled it. It looks like there is a monitor (like a mobile phone shape), and those little discs I see some people wearing. I’m guessing the discs need replacing? I wonder if she already has the… receiver? since this looks like a long-term thing, and she only needs replacement discs?
That makes sense. If she can do it a cheaper way and she doesn’t already have the receiver/meter, I can see that the government would offer to cover the cheaper alternative. If she’s been using the ‘sensor’ all this time, and she already has the receiver/meter, I don’t know if it’s reasonable to tell her to stick her fingers. I don’t know the relative costs.
In any case…
It sounds like everyone is covered for what they need, but the Canadian government will only provide the least-expensive option for whatever condition a patient has. I assume there are private insurance options in Canada?
This is what some in the US have tagged as “rationing!” Like any managed system, people cannot get anything they want any time they want - it’s free, but not a free-for-all. Otherwise the system will run out of money toot-sweet. Not every device, medication, procedure, etc. will be covered. Even here in the US, we have to get stuff not offered at the first tier by our insurance “prior approved” before we can get it - meaning you/your doctor need to jump thru a few hoops, and there is no guarantee you will get what you want (but you will likely get what you need). I suspect the Canadian system works in the same way - some things are approved right off the bat, while others are not, without some sort of justification. AIUI CGM are not usually a first tier item in the US, either.
Right. In the U.S., it’s rationing. And we also have Death Panels. Seems like UHC is better, more humane, and cheaper. But I’m getting off-topic. I was just curious about why the Facebook woman wasn’t getting what she needed, as I understood everything would be covered. I didn’t know that she was asking about an expensive device (or expensive ‘reloads’), and that UHC still covered the prescriptions the expensive thing was meant to replace.
Sometimes as technology advances, new and expensive options become cheaper over time and will eventually be included in coverage. This happens in the US insurance-based system as well. Then, a new-fangled thing comes into play and is effective but expensive, and wont be covered, initially, due to the cost. This is how the risk pool is managed - keeping costs under control so more people can be served over the long term.
The round things worn on the arm and abdoment are the sensors and you wear them for up to 15 days. There is no separate device - the sensors send the result to your smartphone. That’s why the Facebook poster is asking for any one of three types of sensors.
But here’s a couple of things that most non-diabetics wouldn’t necessarily know. First , CGMs are generally only prescribed for insulin-dependent diabetics. And second, lots of people who are not insulin-dependent diabetics want them - enough so that there are OTC version in the US. I’m not sure what the difference is.But it’s possible that the person’s issue is that it’s not considered medically necessary for her.
I googled again, and it looks like there are dedicated receivers for people who don’t have smart phones.
Why do the discs need replacing every 15 days? Do they contain a consumable substance? Are they expensive? Are Type 1 diabetics not always insulin-dependent?
That makes sense. I assume something like a knee replacement would not be medically-necessary until the patient needs a walker? I guess my question becomes: In the Canadian health care system, what makes something ‘medically necessary’ or not?
It’s not just a negotiated price – the prices of prescription drugs are regulated under the Patented Medicine Prices Review Board. Also, just like seniors, the poor will have prescription drug coverage.
Except in rare special cases (like a super-expensive experimental drug not in the formulary) there is no pre-approval process in Canadian health care. It just doesn’t exist, and the absence of that bureaucracy not only keeps costs down but guarantees that everyone will have access to needed care.
I don’t know - but I know Type 2 diabetics also monitor their blood sugar and not all of us are insulin dependent. I also know people make mistakes ( Typing 1 instead of 2) and some don’t always tell 100% truth when they are looking for donations.
There are enzmes in the tip that are consumable and also, if you leave anything stuck to the skin ( sensor, adhesive tape) too long it will cause skin problems. Which is another thing that can fail, the adhesive.
Costs depend on which brand and whether the manufacturer has a savings card for the uninsured .
UHC does not cover medication for most Canadians, just medical treatment. I am on a number of expensive meds at a total of about $1000/month. My work insurance pays for all of it with the exception of the $12/script dispensing fee. If I did not have private coverage, I would be covered by a provincial plan only if I were under 24, over 65, or collecting welfare.
National Pharmacare is in its infancy and currently there are only deals with 4 provinces/territories and only diabetes drugs and contraceptives are covered.
