Everything You Ever Wanted to Know about National Health Plans ….and maybe more - Canada

I'll try again because the first Canada blog got really messed up. Sorry Robert.

Spending on health care to reach $5,170 per Canadian in 2008

November 13, 2008—Canada’s health care spending is expected to reach $171.9 billion in 2008, or $5,170 per person, according to new figures released today by the Canadian Institute for Health Information (CIHI). This represents an increase of $10.3 billion over estimated expenditures for 2007, or a growth of 6.4%. These figures are featured in National Health Expenditure Trends, 1975 to 2008, Canada’s most comprehensive source of information tracking how dollars are spent on health care in this country.

When looking at health care spending as a proportion of Canada’s overall economy, health expenditure is expected to reach 10.7% of the gross domestic product (GDP), the highest share ever recorded. This rate has climbed gradually, from 10.0% in 2002, to an estimated 10.6% last year.

Since 1997, the public and private sector shares of total health expenditure have remained relatively stable, with governments accounting for 70% of total spending and the private sector (including privately insured and out-of-pocket expenses) for 30%. In 2008, public-sector health care spending is expected to reach $120.3 billion (70.0% of total spending), compared to $51.6 billion spent by the private sector (30.0% of total spending).

Spending on health varies from province to province.

Canada's spending :
1. Alberta and Manitoba, at $5,730 and $5,555, respectively
2. Quebec ($4,653)
3. British Columbia ($5,093)

Among 25 countries that have comparable accounting systems in the Organisation for Economic Co-operation and Development (OECD) in 2006, the latest year for which data are available, spending per person on health care remained highest in the United States (US$6,714). The U.S. was followed by Norway (US$4,520).

Seismic shift in cancer drug funding to private payers.

The Cancer Advocacy Coalition of Canada reveals steady shifting of cancer drug costs from public to private insurers, leaving employers and individuals to shoulder the increasing burden of cost. "Expenditures for oral, take-at-home therapies now represent approximately half of the total for all cancer drugs," says Dr. Kong Khoo, a B.C. medical oncologist and lead author of the study. "Employers and insurers should be made aware of the magnitude and pace of these shifts."

Private insurance plays a critically important role in assuring access to medically necessary prescription drugs. The CAC says the bigger issue is that a reasonable 20% co-pay on a $60 average drug becomes unaffordable when the drug costs $25,000 or more and suggests that pooling high cost drug claims — often catastrophic to patients and their families — is an idea whose time is long overdue.

Private Health Insurers’ Roles To Expand As National Healthcare Costs Soar, Projects PricewaterhouseCoopers

31 October 2006 - Governments around the world are looking to expand the role of private insurers as a source of funding the delivery of healthcare, according to a new report issued today by PricewaterhouseCoopers. The report entitled “Healthy Choices: The Changing Role of the Health Insurer,” forecasts that the threat to governments’ fiscal objectives from rising public sector health expenditures will drive the expansion of private sector contributions, and this trend will reshape the health insurance business model globally. Risk sharing will grow as consumers pay more of the cost of their care and efforts to control health costs focus on the reduction of frivolous healthcare claims and over-usage.

Critical Illness Private Insurance in Canada
TORONTO, March 4 2009 - 61 per cent of Canadians admit they have no plan ready in the event they are diagnosed with a critical illness, reveals a recent survey of more than 1,600 Canadians by Ottawa-based polling firm, Redfern Research. Many are concerned about the time it takes to see a specialist, and then get the necessary tests done. And a growing number see the need for critical illness insurance to cover costs the healthcare system doesn't cover. Bottom line, Canadians believe their healthcare system will be there for them if they do become critically ill - but many feel under protected.

Private sector health care spending continues to increase while access to non-emergency surgery has improved in recent years, according to the Canadian Institute for Health Information's Health Care in Canada 2008 report. Total private-sector health care spending - which includes payments by health insurance providers as well as individual Canadians' out-of-pocket expenses - was an estimated $47 billion in 2007, up 5.7% from $45 billion in 2006.

While health care spending is on the rise, it appears that wait times for elective surgery are down slightly. In 2007, 32% of Canadians reported waiting less than a month for elective surgery, compared with 15% in 2005, according to a Commonwealth Fund international survey cited in the CIHI report.

Small drop in median wait times for surgery

The median wait time for Canadians seeking surgical or other therapeutic treatment dropped to 17.3 weeks in 2008 from 18.3 weeks in 2007, according to new research recently published by The Fraser Institute. This year's report shows the main decrease in wait times occurred in the time between a referral from a general practitioner and consultation with a specialist, which decreased to 8.5 weeks from 9.2 weeks. This nationwide improvement in access reflects waiting-time decreases in 7 provinces, while concealing increases in waiting times in Saskatchewan, Nova Scotia, and Newfoundland & Labrador.

Waiting for diagnostic and therapeutic technology The waits to see a specialist and to receive treatment were not the only delays facing patients in 2008. Patients also experienced significant waiting times for various diagnostic technologies across Canada: computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans. The median wait for a CT scan across Canada rose slightly to 4.9 weeks from 4.8 weeks in 2007. Alberta and Ontario had the shortest wait for computed tomography (4.0 weeks), while the longest wait occurred in Prince Edward Island (19.0 weeks). The median wait for an MRI across Canada fell to 9.7 weeks from 10.1 weeks in 2007. In 2000-01, Statistics Canada data showed that an estimated 4.3 million Canadians had difficulties obtaining routine care, health information or advice, immediate care for minor health issues, and other first contact services, and approximately 1.4 million Canadians had difficulties gaining access to specialist visits, non-emergency surgery, and selected diagnostic tests (Sanmartin et al., 2002).

Twenty percent of those who waited for the latter three specialized services indicated that the wait affected their lives; most of these people experienced “worry, stress, and anxiety, pain, or diminished health as a result of waiting” (Sanmartin et al., 2002). Over 20 percent of the 1.4 million also indicated that their waiting time was unacceptable (Sanmartin et al., 2002). Polls regularly show that Canadians are concerned about wait times and the general state of the health care system.

We're finally getting an MRI scanner, but it's only a base unit. Upgrades are essential.
It's about time!" says Chief of Neurosurgery Dr. Brian Hunt. "Lions Gate Hospital has been performing neurosurgery since the 1960s, yet unbelievably we are one of the only neurosurgical units in North America that doesn't have an MRI scanner."

Interactive webpage map for health care costs of each Province:

http://ebnc.benefitnews.com/news/seismic-shift-cancer-drug-funding-priva... Seismic shift in cancer drug funding to private payers



http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_13nov2008_e Spending on health care to reach $5,170 per Canadian in 2008








Great post but folks need to realize. blog pieces are like newspaper articles. So you wouldn't put an apology to someone as the first line in a newspaper article right?

Also, you need to format your links. I showed how but raw links in blog posts is not good juju.

Ah so that is what

raw links are?

Yes you showed me but I wasn't sure how to do it. I didn't want to open the rich text editor because of the problems this morning.

I'll go back and check out your post from yesterday.

Canadian Healthcare

I had a friend that did a lot of IT consulting before. He bitched and complained about Canadian Taxes and also about their health care. Well while on travel, on consulting gigs, he had two heart attacks. When he saw his Canadian doctor, he was advised to retire. Without all those Canadian Taxes and nationwide health care he could not have retired. You can't do that in the U.S.

It costs about 1K plus a month if you are self-employed to get a health plan in the U.S. I hope we get a nationwide health care.

Where in the world do you live?

I've been self employed for over thrity years. That makes me closer to sixty than 50. I don't pay 1K for insurance.

"It costs about 1K plus a month if you are self-employed to get a health plan in the U.S. I hope we get a nationwide health care."

You do know that retirement is not healthy for men. Look it up. They don't live as long. Two heart attacks? Must have been massive because I know a number of people that have had multiple heart attacks and still work. My uncle had his first heart attack in his early forties. He worked till he was 65 and did eventually die when he was in his seventies.

"Without all those Canadian Taxes and nationwide health care he could not have retired."

My posts are going to be more about the costs and associated problems. The moral aspect is left to others to banter about.

If we want to talk morality of plans I could have posted this:

"A spokeswoman for health minister George Smitherman said Wednesday the minister cannot intervene in the case of Sylvia de Vries, the Windsor woman who spent $60,000 in the U.S. for life-saving ovarian cancer surgery in October of 2006 and whose claim for compensation has been denied by OHIP.

She said the case of Suzanne Aucoin, the St. Catharines woman who was awarded $70,000 in 2007 after being treated with a cancer drug out of the county, was different."

Who is your insurance company?

"I've been self employed for over thrity years. That makes me closer to sixty than 50. I don't pay 1K for insurance."

I'm currently looking for self-employed insurance in Oregon. I'm having problems insuring my family of three for less than $1000/month at half your age. Got other problems such as pre-existing conditions though.

Executive compensation is inversely proportional to morality and ethics.

Maximum jobs, not maximum profits.

California, families

He's probably not making it up. In California is it beyond absurd expensive and even then they won't cover even a damn aspirin. Plus don't forget families vs. individual.

I knew there was a reason I left

CA in 1985. Sold my home and moved east. Every freak'in thing in that State is $$$$$$. My brother in law is selling his house for $4 million. In my State he could get 39 acres of land, a much bigger house and pay $750,000.

FUBAR state

frankly. They won't do anything realistic on illegal immigrants or anything at any time that might upset the political oligarchy, big business runs certain areas of the state, even when they are constantly on the brink of collapse. Absolutely nothing on employment law, workplace abuses. You cannot sue for anything because of the legal system. Unless you have a multi-million dollar case, there is pretty much no way to get justice and that includes small business....

It's a shame too because they have great resources.

I lived there too and with all of the great liberal rhetoric of diversity, equality and so forth, I have never seen an area so socially stratified than there. Seriously, not a black person in Silicon valley as far as the eye can see, women clearly being subjugated to work positions less than their abilities dictate, older workers being treated like garbage...even when it's very clear they are the ones actually get the products out the door and solving problems...(due to their experience), again in tech..but the biggest thing was listening to some liberal rhetoric all the while that very person just stepped over the homeless while entering their apartment. And if someone goes down financially, you can bet no one will lift a finger to help that person....just more nice sounding rhetoric. Truly the land of the haves and the have nots.

They ain't even small business friendly either!

Its almost financially prohibitive to start up a company in that state. I was watching Meg Whitman from eBay being interviewed and she echoed what a friend of mine said to me years ago when he was looking to expand. She was going on about how eBay needed to open up a new facility and that it took 2 years just to open up a new office with a server farm and reams of forms that for the most part duplicated each other's purpose. Now Frank, my friend, had a small metal shop that made parts for body shops somewhere near LA. Frank's a good guy, not some plutocrat and he never hired an illegal. Well too wanted to open up a new shop back in '92. He had purchased a second home to be near his mom in the center of the state and saw a good business opportunity. I'll tell you, body shops can be a good enterprise! Well here he is trying to open up that second shop and he too has to go through the beuracracy. Years later, he has to close up that second shop, why? Costs and taxes he says. And last year he closed up his first shop and decided to go to Texas to open up and then eventually retire.

Yep..in the 13 years I lived there

the hypocrisy was piled to the rooftop. They talked a good game, elite sounding to the core but when the rubber hit the road they were no place to be seen.

While living in SF, I had a penchant to help at soup kitchens (is that PC) in the Tenderloin and saw very few of the well heeled types.

Palo Alto is filled with companies that have a mission to help as many USA companies as possible to move offshore. They have no problem making 6 figure incomes while they watch America die.

To me I saw more of the me, me, me generation than anyplace I've lived. What I saw helped the cynical side of me grow larger and larger.

These guys have reasonable

These guys have reasonable health insurance for the self-employed. http://www.nase.org/ Just an FYI.


Yes, their premiums are reasonable- but they are, quite literally, major medical only with huge deductibles. My son's birth was on NASE- $6000 out of pocket for the co-pay on an $8000 bill.

Needless to say, I was very happy when I got the state job for a while and got off of NASE and on to Providence.

But now I'm looking for self-employed again, and this time around, I can't afford the huge deductibles. Oregon Medical Insurance Pool, though, looks like an option- and now that we've been denied a few times, we may be eligible for it.
Executive compensation is inversely proportional to morality and ethics.

Maximum jobs, not maximum profits.

Same boat

Self employed, I went through a period of no real health insurance suppliment to my Medicare (I'm disabled). Blue Cross Blue Shield of Illinois wanted North of $650 a month for me for regular insurance, half that for suppliment. Ended up going to Humana for about $100 a month with one of their (now realized) awful Medicare Advantage plans.

Medicare Advantage Plan

are a project where the government and insurance companies have combined. The government has strict guidelines that the insurance company must follow the government pays the insurance companys.

Now what I find weird is that I know a lot of old people. I play piano at a senior center. The figures I hear you all coming up with are nothing , not even near what the seniors pay. Even for a non Med Advantage plan the rates I am hearing seem odd. From what the seniors tell me the Centers for Medicaid and Medicare set the rates for Medicare Advantage, the rates are not based on age/sex. There are seniors there that have plans that they pay $0 for and a lot are paying about $50. Apparently there are some plans that are about $100 a month and allow more freedom to go where you want.

I have a friend who has a 40 year old daughter that is disabled. The daughter is on Medicare. I didn't know a 40 year old could get on Medicare but he says yes if the government declares you totally disabled. Her meds are outrageously expensive. She has a Med Supp with BSBC and it only costs @$150 a month. She has a co-pay for drugs but the insuance pays for most of them. He did say something about a donut hole that the government mandated. Donut hole???

I hear the seniors at the center talk about their health stuff. It is a big deal to them. The majority like their Medicare Advantage plans. Maybe you should check out a different company. I have never ever heard any seniors talk of a $300 a month Medicare Advantage plan. If they were charging you that much I would check into fraud.

I was there to play piano the day an insurance company came to do a dog and pony show. The max premium was $100 a month and the guy said that Medicare will only allow a certain premium.

Check it out....the may owe you money.

Regarding your post

I have to say thank you for posting this. Ironically enough I was at the doctors today (been having complications of sorts) and well since he had no other patients that day (odd since his office is normally busy) we chatted. The topic? Health coverage. I think he nailed it when he say the blame comes from four sides, the Government, the Insurance companies, tort and the medical equipment providers.

With the Government, he was showing me the actual forms and books they need to use. See, when you're on Medicare or Medicaid, what I learned today was that sometimes that checkup would have to be regarded as 4-5 different things. This book, actually it was three of them, had to be the size of phone books! You catagorized it wrong, and Uncle Sam won't pay you. On top of that, the rate is discounted below market prices. Now my doctor ain't cheap but he doesn't over do it either. When I had nothing, office visits were about $60, and after some in-office tests (his group invested in their own lab), my bills were around $300 tops. I've had other doctors, and have seen bills has high as $5k-9k for tests and stuff done at the hospital. But getting back to the government, he showed me the hoops he has to run through to just get paid. Indeed, this also tags with the insurance problem.

The insurance companies make him almost do the same dance. He has three ladies who just deal with the insurance and government paperwork. THe insurance companies try to screw him over more than the government, he says. He told me about things like how companies, like my Humana, will create a new plan that sounds just like the other Medicare plans but covers less. Then he told me about "Chameleons," a nickname many in his industry have dubbed to what he thinks is the biggest case of fraud yet still legalilzed. So what is he referring too? What if I told you that the insurance you think you own isn't who they really are. Case in point, he told me about how a Blue Cross Blue Shield outfit essentially rents out their name to smaller less scrupulous insurance companies. The person buying those policies are made to believe its BCBS, but in reality isn't. When that person sees the doctor and is given a bill higher than what they were told, they find out that the version of BCBS doesn't even come close to covering what the actual Blue Cross plans do. Its legal because of certain loopholes.

The insurance companies, along with the government plans (including Medicaid) have been cutting back. He showed me one sheet from 2007, one from 2008 dubbed that was part of a large folder of documents, it had a fancy title but it was basically changes to coverage and payments. He showed me how we're cutting back drastically. I asked about the private insurers, he grimmaced saying at least the government was more explicite. Some, as he explained, were going into what he termed "membership fees" for consultation. The way things are going, both the government and the insurers are pointing coverage in a direction where all one will get is as basic a care as possible. He told me, from the outlines he's seen, you really all will need is a high end nurse to do the "new physical." If you want "luxury care" you may have to pay the doctors a yearly fee for unlimited consultation. Frankly, I found this disturbing.

He then told me about how, despite not having one person in his outfit being sued, his malpractic has skyrocketed. A lot of doctors are moving out of general practice. We both could see how if a doctor screwed up he should pay. But the costs have simply gotten out of hand.

Last, but not least, there is the medical equipment providers. Now here he didn't show me as much as my friend Debrah. Debrah runs a laminating manufacturing firm in Skokie, Illinois. One of her clients, and long-time friend is this gal who I think is named Carole. Well "Carole" works for a company that sells things like stents and other such things. Debrah was thinking of setting up a company to sell these products (there isn't much demand for lamintors these days).

She learned how a lot of the stuff they buy costs literally pennies but they turn around and sell them at much higher prices. There was this little plastic thing, no bigger than the head of a pin, but tube shaped that went for I think was hip joints or something. Anyways, she said the thing costs the company literally $.50 a piece. So how much is it sold for? YOu ready? $500. The doc also showed me how he found some equipment sold for labs going for hundreds of dollars selling in asia for a fraction of that.

You know, in the news you read about how we will need the money to meed exploding healthcare costs. The article above talks about it. But when do you hear about investigating such costs? Why are they going up? I understand demand and supply, but you're telling me there isn't a viable competitor making it cheaper? How is it in other parts of the world, these plastic or what have you things are cheaper but not here? We need to tackle the costs, my friends.

Lastly, what spooks me about "universal health care" is the waiting. Yes, I've seen the documentaries that show a lot of the so-called long waits are overblown. I've seen Sicko. But I also have family in Canada, in Kichiner, and the one that sounds like Mississippi. They tell me that Sicko isn't telling the whole story. And then you hear about the rationing. Look you could make the argument that thats what we got going on now. No argument from me there. But I want a back door if the government says it is making cutbacks and rationalizes that because I'm deemed too costly that the "cheaper" alternative is what will be given even if it doesn't do jack. At that point, perhaps we should have the ability to buy a suppliment that will cover instances that the government won't pay.

All I know, is that a lot of people can't afford health insurance. The insurance companies are trying to screw over their customers. But we also can't have these multi-week waiting periods even for something as an x-ray. And we sure as hell can't have rationed health care....be it in a nationalized health care or semi-private one!

At the end I will address Medicare

Your doctor hit a lot of the problems. Imagine if people just paid the poor guy when they went to see him.

When a Dr. sees a Medicare patient:

1. Physicians must make 11 decisions to select the proper Evaluation and Management (E&M) code, according to Medicare program guidelines.
2. Each decision point requires several choices.
3. There are a total of 42 choices a physician must consider in choosing the proper E&M code.
4. There are 6,144 possible combination's of items involved in properly classifying a new patient office visit

Medicare does deny claims but the people at Medicare that deny claims enjoy nearly iron-clad protection from being held accountable for their actions under "Official Immunity" and the "Medicare Preclusion Law." Under "Official Immunity,"

They cannot be held accountable as long as they were acting within the broad scope of their authority under the Medicare program-in which Medicare people write all of the rules and regulations. Under the "Medicare Preclusion Law," 42 U.S.C. Sec 405 (h), no lawsuit can be brought against a Medicare contractor or employee"

I have more on Medicare that will be provided after all the universal plans are presented.

Medical equipment is just insanely expensive. I imagine the manufacturers may do some gouging but they also may (no evidence here) probably use the best, best materials. If there is ever a failure the tort system would eat them alive. So they probably over engineer a lot of the stuff.

Anyone that is in business knows that it is the cost to defend that is the nasty item. Those small nuisance claims still need to be defended. Tort reform would help. A Physician Liability 2006 Benchmark Analysis, examining more than 47,700 claims representing more than $4.4 billion of incurred losses, found that while claim frequency is stabilizing, the average size of claims continues to increase at a rate of 6 percent a year. The average amount paid to plaintiffs increased only 3 percent, while amounts paid to defend against liability claims rose 17 percent as hospitals mount a more aggressive defense of claims.

My friend that owns a cabinet shop has seen his general liability policy go from $600 15 years ago to over $4,000. People will sue him even if they use his cabinets as a ladder and the cabinet tilts back and they fall. yep...it was one of his own real episodes.