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September 15, 2012

Canada: What universal health care?

Reuel S. Amdur

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It is claimed that Canada has universal health care. Unfortunately, that is an overstatement.

Let’s consider the shortcomings, beginning with mental health issues.  These are among the most seriously pressing.  With treatment programs, especially for children, seriously lacking, much of the heavy lifting is left to family.

One could address the issue by looking at diagnoses, such as autism, where publicly funded services are seriously lacking, even in provinces that attempt to address the problem with appropriate programs, or we could list professions.  Among the professions that are in large excluded from universal coverage are psychologists and social workers.  At the same time, psychiatrists are covered, meaning that the system is tilted by coverage of the most expensive professional services.

Psychologists and social workers in institutional settings such as hospitals and schools are accessible without charge, and some are also found in various social agencies, where services may or may not be covered by a fee-for-services arrangement.  However, many are private practitioners.  A few years ago, the Ottawa Hospital canned a group of psychologists, as a money-saving measure—money-saving for whom?

Moving away from mental health, we find the same spotty character of the supposed universality.  When George Smitherman, who was then Ontario Minister of Health, eliminated vision care from covered listed services, he reacted angrily to criticism.  Yet, while many people can function with bad vision, good vision is clearly preferable.  His action was just one more blow to universality. 

Besides optometry, other health practitioners operate outside the medicare umbrella.  Dentists, chiropractors, osteopaths, podiatrists, and chiropodists come to mind.  They are or are not covered to varying degrees, depending on the jurisdiction.  Ontario has various schemes covering some of these to one degree or another on different programs, some with partial payment.  The partial payment approach involves extra-billing for some of these professions, a long-standing practice that appears to violate the Canada Health Act’s prohibition of extra-billing. 

Yet, foot health issues, treated by podiatrists and chiropodists, are a major factor in seniors’ mobility and should clearly be part of a universal health care program.  Back problems, often work-related, are treated by osteopaths, chiropractors, and physiotherapists.  While some physiotherapists are institutionally based, many are in private practice.  The same is true of occupational therapists, who deal with both physical and psychological adjustment and rehabilitation.

When it comes to hearing problems, I have a personal story to tell.  I live in Quebec and put my name on a hospital waiting list for a hearing test.  Then I received a form letter telling me that I could continue on the waiting list for the testing, a wait of several months, or I could contact one of a list of private hearing clinics and pay $50 or $100 to get the testing right away.  Ever hear of two-tier health care?

Drug costs are another example of the lack of universality.  A recent study found that low-income Canadians are apt to be unable to afford prescribed medication.

Canada is a country with an aging population.  Yet, as Canadian Medical Association (CMA) President John Haggie has pointed out, home care and long-term care are neglected in our so-called universal program.

Finally, CMA president-elect Anna Reid, as well as Haggie, points to the issue of poverty and social determinants of health.  If not everyone has an adequate quality of life, then we increase the burden of health care expenses.  The poor are sicker than the rest of us.  Hence, progress toward greater equality means better health, and greater equality depends on government policy.  Thus, in the grander scheme of things, universal health care needs to encompass progressive social policy, or vice versa.

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