How's your local health care?

Miscellaneous and Personal Stuff I Must Share
1

I started this thread so I and others can vent about their local health care.

I live in Quebec and in many ways the government funded health care is awful. One example is that they have abandoned preventative medicine. There is a recent New Yorker article by Atul Gawande about how Costa Rico has gone all in on preventative medicine and the marvelous results they get. It is unfortunately behind a paywall, but here is the link: https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret.

Long ago Quebec started disallowing annual checkups for grown-ups; they are now going to disallow them for children. A few decades ago, they started to encourage new doctors to go out to the underserved rural areas by paying a financial penalty for setting up in Montreal. It worked and now there are no new doctors in Montreal. As a result, when my family doctor retired in April (not Covid related) and I started to call around to medical practices nearby, it turns out that none of them, 0, are taking new patients. I asked about a wait list. Nope. The province “guarantees” you a primary care physician. So I contacted them last November (I knew the retirement was imminent) and yes they guarantee a primary care physician, but the expectation was that it would take a year and a half! And might be in the other end of the city. And my wife and I might be assigned different doctors. We are, incidentally, 83 and 84. If one of us requires acute care, the only choice is an emergency room. But for ongoing problems, no help. For example, owing to various drugs I take I am supposed to have some blood tests every six months. I have not had the tests in over a year. (I should mention that our doctor gave us prescriptions for two years when he retired.)

A few years ago, the province paid a lot of near retirement age nurses to take early retirement. Now they are offering a bonus to come out of retirement. I think a lot of that is Covid related. But they are desperately short of doctors as the above suggests. Many of the doctors who didn’t want to go out to the sticks simply moved to Ontario or BC or even to the US.

On the other side, general medicare is free. Dentistry, eye glasses, hearing aids are not covered, however. We pay an annual premium that covers most our prescription costs. Still, I have to say that the government funded medicare isn’t all it’s supposed to be.

2

I live in Alberta. It’s not AHS that’s the problem, it’s the government systematically trying to downgrade services to “prove” we need privatized healthcare. I’d be a very happy camper if Kenny and Co. came down with Covid and dropped dead.

3

I also live in Quebec at the moment though, with my former military service, I’ve seen second-hand, via my wife, what health-care is like in Ontario and Nova Scotia as well. I greatly, greatly appreciate that we have government funded health care, though staffing numbers are brutal, so it can be difficult, if not impossible, to get a family doctor. Wait times are bad and I’ve never understood why dental, glasses, and drugs are excluded - that just seems arbitrary and counterintuitive to me.

Having said that, in Halifax my wife had a horrific cancer battle and received excellent care and treatment from the nurses and doctors (despite the “system”) and has had really good follow-up here in Montreal, and we didn’t get financially ruined by the experience.

4

I live in the Cleveland, OH (USA) area and we have a glut of health care options. The Cleveland Clinic, University Hospitals, Metro Health and Summa. They’re building new facilities every year.

That being said, there still are wait times for specialists and testing, even before the pandemic. Wait times have been worse since the pandemic of course.

And, it’s all very very expensive.

5

Yes, get sick enough and the care is excellent and free. I agree with all that. It is just the routine care that sucks. And abandoning of preventative medicine.

6

Am in the UK, so receive care under the NHS.

Historically it has been generally brilliant - everything covered (including preventative, IVF, some dental, subsidised eye tests), but in these Covid times it has just become more and more difficult to get a GP appointment (and you can pretty much forget F2F, they’ve found zoom, and they love it), and the waiting times for more specialised care stretches long into the distance.

I would hope that things settle down/speed up soon, but then we’ve got Johnson and the Tories in charge, and they aren’t exactly known for lavishing money on the NHS, whatever they might tell the Daily Mail.

Having said all that, my GP has called me in for my (free) flu jab, and hopes to give me my covid booster at the same time, so not everything has ground to a halt.

7

I guess I’ve “opted out” due to being dissatisfied with my local health care. The last few times I saw my PCP, all he did was complain to me about how the US health care system sucked. I didn’t disagree, but I also wasn’t there to hear him bitch. Eventually we got in a nasty argument and each yelled, “Fuck You” at the other.

He then retired. The office has attempted to contact me several times, I assume to hook me up with another PCP in the practice, but I just throw out their mailings as junk.

8

Absolutely! If you’re sick enough to be in hospital when you get your drugs they’re paid by the tax-payers. If, however, you get discharged and you’re taking them at home they’re not.

9

The abandonment of preventative medicine is rather horrifying - especially with CHILDREN. And the shortage of primary care practitioners in general - I’m surprised the province is not doing all they can to attract more, as it’s much more cost effective than seeing a specialist or an emergency doctor for everything.

For a long time in the US, preventive care was pretty tricky to get as well as insurance simply wouldn’t cover it. There had to be some diagnosis on the paperwork. Being “lucky” enough to have a chronic health condition (asthma), they always had at least one diagnosis to put on the paperwork, but my son, for example, might have had real trouble. I suspect a lot of people got “diagnosed” just to get their visits covered.

With Obamacare, preventive care is supposed to be covered 100%. I remember the first colonoscopy I had after it went into effect was fully paid - which was not quite right in my case, as it was NOT a screening procedure. I’ve seen people say here that their colonoscopy wound up not being covered if any polyps were found, because suddenly that turned it from preventive into diagnostic or something, which is baffling.

As far as current access: Well, in the US, if you have insurance, you have access to healthcare, though a) if you’re not near a major city, some driving is required, and b) it can wipe you out financially even with insurance. There can be nasty surprises like a non-network provider giving care in a network hospital (friends of ours got bitten by that). If you don’t have insurance, of course, it’s best for everyone if you just hurry up and die (that seems to be the attitude, anyway).

In my immediate area, primary care is a little problematic: it’s a wealthy-enough area that a lot of doctors have gone to concierge medicine. I had two primary care docs in a row go that route. Others simply don’t deal with insurance at all - you pay out of pocket, and file with insurance on your own as having visited an out of network provider (my sleep doctor is like that).

I asked my gyn if she had any recommendations and she suggested I look for a doctor in a larger practice (several local hospital systems have networks of specialists and primary care clinics). I stumbled across a doctor, new to the area, who was affiliated with one such; she had great patient reviews from her previous city. Because she was new, it was easy to get on her caseload (she got loads busier later and it took longer to get an appointment). And I knew the odds of her going concierge were fairly low.

Then she up and moved to New York. Honestly, I was beginning to take all this personally :D.

I actually got passed on to one of the other docs in the same practice, and that’s going OK.

So in general, while finding a primary care doc may be slightly challenging, there are enough out there that, if you’re in a major metro area, you’ll find someone, and if you loathe that person, you can usually find someone else. As noted, specialists take longer.

As far as something like surgery: I went from “have you seen a hand specialist?” to “on the table” in 5 days when my wrist developed problems. Given that the doctor thought I had other tendons at risk from the same issue, it might have been fairly fast even in Canada (or it might not). When my gallbladder started misbehaving, I could have had surgery within 10 days of meeting with the surgeon. I declined that slot because it was something like 2 PM and I knew it would be delayed by hours. So I waited another 2 weeks. Meanwhile, a friend’s husband, in Alberta, had to wait 3-4 months, and then take whatever slot they gave him. BUT - neither was an emergency, and he spent a great deal less out of pocket than I did (as in, nothing).

Costs: We have a high-deductible plan, and we usually hit our out of pocket limit (which means the insurer pays 100% of costs after that happens). Looking at what we pay in premiums, what the employer pays, what we pay directly, and what the insurer pays, it’s probably about 50,000 a year in medical costs. Quite a bit more than that, if we have a bad year (like 2018, with 2 orthopedic surgeries and a few other things). To be fair, we have several chronic medical conditions which require medication - but 50K a year sounds pretty extreme. If we have a good year and don’t hit the out of pocket, total spend might be 30-35K (just a WAG though).

10

I’ve had decent care. I hit all the high points, chronic disease, expensive meds. Specialized care needed. So I’m covered well.

My DIL had a heck of a time finding an OB/gyn for her pregnancy. She’s having to do a long drive.

We all have good insurance. Expensive, but good.

11

@Hari_Seldon the shortage of PCP’s isn’t due primarily to the financial penalty to disincentivize family docs from practicing in Montreal. Both Canada and the US are facing a growing shortage of family physicians. A doc explained to me that fewer med students are going into the field, as it pays less, and there’s little prestige.

It’s also simple arithmetic: as the populations of Canada and the US age, the ratio of family physicians to patients will continue to drop.

Many people I know don’t have a family physician and have to settle for nurse-practitioners or PA’s, who are fine for simple sore throats or pulled muscles, not so good for more complex conditions.

12

I’m paying about $8,700 a year for insurance and it’s a really good plan. I just had pretty major surgery recently. The total billed to the insurance company was over $400k. Total cost to me? Zero. I’m paying a lot more for my PT afterwards than the surgery itself because it’s billed differently. I can’t complain but at the same time it also shows how bad it is for those who don’t have insurance

13

My experience of the NHS in London is much as SanVito’s. My GP centre calls me in for regular blood tests and reviews to check up on my medications, and they seem as thorough as ever in checking out possible side-effects.

I don’t mind that they’ve shifted as much as possible online, it seems to me to be quicker, certainly than waiting in a phone queue.

Case in point: after the most recent set of blood tests (I’d already seen them online), the doctor rang to go over them. I had an infection in a toe and asked him about it. Fortunately I’d taken a photo, and he texted me a link to upload it so he could see it, at which he asked me to visit the centre that afternoon. Which I did, he swabbed for a sample and prescribed antibiotics (electronic, so available at the designated pharmacy straight away). Of course, it might have been the swifter because he had a medical student in on observation, but it didn’t strike me as atypical. But London is notoriously better provided than some other parts of the country.

14

I’m in Ontario, and while the situation is similar as described by @Hari_Seldon, I don’t see it as quite as dire. Part of that is systematic, part is my personal health conditions.

While “annual checkups” are no longer a thing, studies were showing they were of little value. This doesn’t mean that they are forgoing monitoring, it just means the doctor isn’t checking your weight and checking for hernias.

Colon cancer checks, mammogram, Pap smears, are still a normal part of care. The family doctor shortage is real. I have been seeing mine for close to 30 years, which puts him at about 60 and I am not looking forward to having him retire one day. Many people complain about not having one and depend on walk in clinics.

Personally, I have routine blood work twice a year and see my endocrinologist 1x year and my GP at least every other year. Whenever I have needed medical care, I’ve always gotten it promptly.

15

You are right about the shortage of doctors wanting to go into family medicine. But there are doctors trained in other countries driving Ubers today because the province won’t let them practice. They are required to do a local residency in order to practice and then severely limit the number of them allowed to do that residency.

Incidentally, my DIL is the director of residency at the only hospital in the US that trains only family physicians.

16

My significant other goes to a Direct Primary Care practice. It’s a bit like concierge medicine but it’s priced affordably. They concentrate on primary care and for a flat fee will see you as often as needed. They take zero insurance. They save a great deal in overhead due to this. I have to say that his care is much better and more comprehensive than the siloed care I get at the big center that takes insurance (as I have health insurance and he does not). I am about to switch and go to them even though it will be more out of pocket.
The only negative is that, as you might expect from a group that is “off the grid” they do have some strong political views, but they mostly keep them to themselves.

17

I have no complaint, I have been very fortunate indeed, and reside in Ontario. I’ve had the same PCP for almost 40 yrs. by coincidence I have always been able to walk to her office. Including immediately after buying this house, she moved her practise to a med building 1+1/2 blocks for here. Also in the building; blood lab, mammo, X-ray, scans, pharmacy, physio! It was pretty sweet. She’s been a marvellous Dr, even taking on hubs when his MD retired. She’s old enough to retire but has no plans to, as yet, though she did pare her patient list, and reduce her hours.

Several years ago, the provincial government encouraged PCP Drs to set up Family practise teams, taking on younger Drs, in prep for upcoming retirements. Which her practise, (3 female Drs), did. So, I know, whenever she does retire we will have a new young Dr immediately, same sweet location. Plus, a Dr I’ve seen before, when mine was unavailable.

As for meds coverage, here it kicks in at 65, patients pay only the first $100, per year. So no complaint there either.

The only cost cutting affecting us, thus far, has been when they stopped covering travel shots/care. And some of that’s not cheap, but it comes out of our holiday budget, and does kinda make sense.

We bought our house to care for my MIL, bedridden after a stroke. We received homecare coverage and medical devices, PT, OT, in home Dr visits, etc, all at no cost to us. For six years!

I have nothing but admiration for my province’s efforts. There are bottlenecks, old folks don’t like to wait for stuff, but most people I know are pretty content.

18

Oooooh - don’t get me started on billing amounts! Oh… too late.

The amounts the provider bills insurance are fiction, pure and simple. I’ve vented about this before, I know, but they have zero expectation of getting that much - and I assume that even if someone was paying cash, they’d be willing to give a hefty cash discount.

IIRC, the rack rate for my gallbladder surgery - and this was the hospital fee alone - was something like 40,000 dollars. The hospital got maybe a tenth of that as they were in-network. That didn’t include the surgeon, whose fee was similarly inflated. The hospital had zero expectation of getting 40,000; they just put any bullshit number they feel like.

I get colonoscopies regularly. I think insurance pays about 2 grand to the doctor and the facility, maybe less, after the in-network discount. The anesthesiologist bills separately; last time I saw a bill, it was about 1,400 bucks. Insurance paid about 400. A friend’s daughter got surprised by one of those “out of network provider” bills at an in-network facility: the anesthesiologist billed 3 times as much (about 4,000). They negotiated it down to something like 400.

Anyway, you might find it interesting to look at your insurance explanation of benefits forms to see what the hospital was actually paid!

19

Oh yeah I’m well aware of the difference between the initial bill and what they will eventually be paid. The dust hasn’t settled yet so I haven’t seen the total amounts on everything. I’m not worried because I already know what my bill will be. It’s just scary to think what the bill would be to someone without insurance